Syrko Marcin, Jabłecki Jerzy
Department of General Surgery, Limb Replantation Ward St Hedwig's Hospital, Trzebnica.
Ortop Traumatol Rehabil. 2010 Jan-Feb;12(1):19-27.
Forearm amputation in different zones via a similar mechanism in a group of patients of similar age is associated with different possibilities of functional recovery. The degree of postoperative recovery of function is invariably partial compared to pre-amputation function; this kind of trauma inevitably leads to disability. The patients adapt to their new circumstances to a different extent. That is why a quality of life evaluation should be included in the assessment of replantation outcomes. The aim of the study was to evaluate functional outcomes in patients after replantation at the metacarpal, wrist and mid-forearm level with regard to the quality of life of this patients.
Thirty patients (29 men, 1 woman) of an average age of 41 years who had had replantation or revascularization surgery of an upper limb at different levels took part in a randomized study. The patients were divided into 3 groups depending on the level of amputation: metacarpal, wrist, mid-forearm, with 10 patients in each group. Amputations had been done by a circular saw (21) or via a guillotine mechanism (9). The patients were evaluated on average 4.2 years postoperatively. The following parameters were assessed: total range of active motion (the long finger with the greatest range of motion was assessed) (TAM), grip strength, and sensation; patients performed the Nakamura-Tamai test (modified). Overall functional outcomes were assessed according to Chen's classification. The quality of life (QoL) was measured with the SF-36 questionnaire (0-136 points). The correlation of functional and QoL results was assessed by Spearman's non-parametric test.
Average TAM was: 167 degrees in metacarpal, 174 degrees in wrist, 114 degrees in mid-forearm group; grip strength was 0.7 N, 0.9 N and 0.6 N respectively. All patients had at least protective sensation, whereas a 2PD of less then 10 mm was present in 4 patients in the metacarpal group, and 6 patients in the wrist group. In Chen's classification 5 patients in metacarpal group were rated as grade I and II, compared to 7 in the wrist group, and 2 in the forearm group. QoL scores were 98.9, 104 and 82 respectively. A strong QoL-function correlation was confirmed in the wrist and forearm groups (0.73 - 0.81 respectively), and in the metacarpal group it was weak (0.43).
The quality of life of patients of the designated groups was correlated with their functional results.
在一组年龄相仿的患者中，通过类似机制在不同区域进行的前臂截肢与功能恢复的不同可能性相关。与截肢前功能相比，术后功能恢复程度总是部分性的；这种创伤不可避免地导致残疾。患者在不同程度上适应新情况。这就是为什么在评估再植结果时应纳入生活质量评估。本研究的目的是评估掌骨、腕部和前臂中部水平再植患者的功能结果及其生活质量。
30例平均年龄41岁的患者（29例男性，1例女性）参与了一项随机研究，这些患者在不同水平接受了上肢再植或血管重建手术。根据截肢水平将患者分为3组：掌骨组、腕部组、前臂中部组，每组10例。截肢采用圆锯（21例）或断头机制（9例）。术后平均4.2年对患者进行评估。评估以下参数：主动活动总范围（评估活动范围最大的示指）（TAM）、握力和感觉；患者进行改良的中村-玉井试验。根据陈的分类评估总体功能结果。用SF-36问卷（0-136分）测量生活质量（QoL）。通过Spearman非参数检验评估功能和QoL结果的相关性。
掌骨组平均TAM为167度，腕部组为174度，前臂中部组为114度；握力分别为0.7N、0.9N和0.6N。所有患者至少有保护性感觉，掌骨组4例患者和腕部组6例患者两点辨别觉小于10mm。在陈的分类中，掌骨组5例患者被评为I级和II级，腕部组为7例，前臂组为2例。QoL评分分别为98.9、104和82。腕部组和前臂组证实了QoL与功能的强相关性（分别为0.73-0.81），掌骨组则较弱（0.43）。
指定组患者的生活质量与其功能结果相关。
