Agarwal Jayant P, Trovato Matthew J, Agarwal Shailesh, Hopkins Paul N, Brooks Darrell, Buncke Greg
Department of Surgery, University of Utah, Salt Lake City, UT, USA.
J Hand Surg Am. 2010 Sep;35(9):1485-90. doi: 10.1016/j.jhsa.2010.05.012. Epub 2010 Aug 21.
The aim of this study was to assess thumb survival, pinch strength, grip strength, and need for secondary surgery in patients undergoing thumb replantation after isolated thumb amputation injury.
We conducted a retrospective review of 52 consecutive isolated thumb replantations performed over a 4.5-year period. Charts were reviewed for mechanism of injury, level of amputation, and surgical technique. Primary outcomes of interest included survival and secondary surgery (eg, tenolysis, neurolysis) rates. Functional outcome was assessed by pinch and grip strengths after a mean follow-up period of 10 months from the initial injury.
The overall thumb survival rate was 92% (48 of 52). One hundred percent of Zone I injuries (13 of 13), 94% of zone II injuries (29 of 31), and 75% of zone III injuries (6 of 8) survived; overall survival was 94% in sharp injuries (32 of 34), 89% in avulsion injuries (8 of 9), and 89% in crush injuries (8 of 9). Secondary surgery was performed in 18 patients with increasing need across the 3 zones (0%, 42%, and 63%, respectively; p for trend = .002). Pinch and grip strengths of 17 patients after an average follow-up period of 10 months were significantly worse after crush/avulsion injuries (p = .007 and .07, respectively) and injuries requiring joint intervention (p = .004 and .02, respectively); grip strength was also found to be negatively associated with increasing zone of injury.
This retrospective study shows that a high rate of survival can be achieved after thumb replantation using current techniques. In addition, the need for secondary surgery is strongly related to zone of injury, with zone I injuries requiring the least amount of secondary surgery. Finally, pinch and grip strengths may be worse after crush or avulsion injuries and injuries requiring joint intervention.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在评估单纯拇指离断伤后接受拇指再植手术患者的拇指存活情况、捏力、握力以及二次手术需求。
我们对4.5年间连续进行的52例单纯拇指再植手术进行了回顾性分析。查阅病历以了解损伤机制、截肢平面和手术技术。主要关注的结果包括存活情况和二次手术（如肌腱松解术、神经松解术）率。在初次受伤后平均随访10个月时，通过捏力和握力评估功能结果。
拇指总体存活率为92%（52例中的48例）。Ⅰ区损伤（13例中的13例）存活率为100%，Ⅱ区损伤（31例中的29例）存活率为94%，Ⅲ区损伤（8例中的6例）存活率为75%；锐器伤（34例中的32例）总体存活率为94%，撕脱伤（9例中的8例）存活率为89%，挤压伤（9例中的8例）存活率为89%。18例患者接受了二次手术，3个区域的需求逐渐增加（分别为0%、42%和63%；趋势p值 = 0.002）。平均随访10个月后，17例患者在挤压/撕脱伤后（分别为p = 0.007和0.07）以及需要关节干预的损伤后（分别为p = 0.004和0.02），捏力和握力明显较差；还发现握力与损伤区域增加呈负相关。
这项回顾性研究表明，使用当前技术进行拇指再植后可实现较高的存活率。此外，二次手术需求与损伤区域密切相关，Ⅰ区损伤所需的二次手术最少。最后，挤压或撕脱伤以及需要关节干预的损伤后，捏力和握力可能较差。
研究类型/证据水平：治疗性IV级。
