Shale Christopher M, Tidwell James E, Mulligan Ryan Patrick, Jupiter Daniel C, Mahabir Raman C
Division of Plastic Surgery, Scott and White Healthcare, 2401 South 31st St, Temple, TX 76508, USA.
Ann Plast Surg. 2013 Jun;70(6):647-51. doi: 10.1097/SAP.0b013e31828986c9.
Traumatic thumb amputations are a common problem with significant associated cost to patients, hospitals, and society.The purpose of this study was to review practice patterns for traumatic thumb amputations using the National Trauma Data Bank. By using a large nationwide database, we hoped to better understand the epidemiology and predictors of attempts and successful replantation.The design was a retrospective review of the National Trauma Data Bank between the years 2007 and 2010, investigating patients with traumatic thumb amputations. Analyses of these patients based on replantation attempt, mechanism of injury, and demographics were performed. Comparisons were made between hospitals based on teaching status and on patient volume for replant attempt and success rates.There were 3341 traumatic thumb amputations with 550 (16.5%) attempts at replantation and an overall success rate of 84.9%. Nonteaching hospitals treated 1238 (37.1%) patients, and attempted 123 (9.9%) replantations with a success rate of 80.5%. Teaching hospitals treated 2103 (63.0%) patients, and attempted 427 (20.3%) replantations with a success rate of 86.2%. Being in a teaching hospital increased the odds of attempted replantation by a factor of 3.1 (P < 0.001) when compared to a nonteaching hospital. Treatment at a high-volume center increased the rate of attempted replantation by a factor of 3.4 (P < 0.001), as compared to low-volume hospitals.Practice patterns show that teaching and high-volume hospitals attempt to replant a higher percentage of amputated thumbs. Success rates are similar across practice settings.
创伤性拇指截肢是一个常见问题，给患者、医院和社会带来了巨大的相关成本。本研究的目的是利用国家创伤数据库回顾创伤性拇指截肢的治疗模式。通过使用一个大型的全国性数据库，我们希望能更好地了解拇指再植尝试及成功再植的流行病学情况和预测因素。
研究设计为对2007年至2010年间国家创伤数据库进行回顾性分析，调查创伤性拇指截肢患者。基于再植尝试、损伤机制和人口统计学特征对这些患者进行了分析。根据教学状况和再植尝试及成功率的患者数量对医院进行了比较。
共有3341例创伤性拇指截肢患者，其中550例（16.5%）尝试进行再植，总体成功率为84.9%。非教学医院治疗了1238例（37.1%）患者，尝试再植123例（9.9%），成功率为80.5%。教学医院治疗了2103例（63.0%）患者，尝试再植427例（20.3%），成功率为86.2%。与非教学医院相比，在教学医院进行再植尝试的几率提高了3.1倍（P < 0.001）。与低容量医院相比，在高容量中心进行治疗使再植尝试率提高了3.4倍（P < 0.001）。
治疗模式表明，教学医院和高容量医院尝试对更高比例的截肢拇指进行再植。不同治疗环境下的成功率相似。
