Kaplan Jesse D, Jones Neil F
*Shriners Hospital for Children-Los Angeles †University of California Irvine, Orange, CA.
J Pediatr Orthop. 2014 Apr-May;34(3):362-8. doi: 10.1097/BPO.0000000000000088.
Outcomes data for children undergoing surgical reconstruction of their congenital hand anomalies has been used infrequently or not at all. Some surgeons even contend that children with total absence of digits or hands function perfectly well. Therefore, the purpose of this study was to evaluate and compare the functional outcomes of children who have undergone microsurgical toe-to-hand transfers for reconstruction of congenital and traumatic hand anomalies with the normal pediatric population.
A total of 10 adolescents and 15 parents of pediatric and adolescent patients who underwent microsurgical toe-to-hand transfers were assessed using the Pediatric Outcomes Data Collection Instrument (PODCI) survey. Surveys were distributed during routine clinic visits or by mail. Indication and diagnosis were analyzed in relation to the functional outcomes obtained from the survey. Scores of the toe transfer patients group were compared with the scores of the normal pediatric population as well as the effect of patient and parent reporting.
Of the 3 survey groups and 6 functional dimensions, there was no statistically significant difference in function between the toe transfer children and the normal pediatric population in 13 of the 18 groups (72%). Adolescent toe transfer patients reported decreased upper extremity function and transfer/basic mobility and parents of adolescents reported decreased upper extremity function, sports/physical function, and global function. Parents significantly underestimated their adolescent children's function in terms of sports/physical function and happiness. Scores did not significantly differ between the congenital or traumatic indications for toe-to-hand transfers.
Children with congenital or traumatic missing or hypoplastic digits who undergo reconstruction by microsurgical toe-to-hand transfer can achieve remarkable gains in function, sensation and ability to perform daily activities. This study confirms that a significant percentage of children undergoing reconstruction by microsurgical toe-to-hand transfers have similar functional outcomes assessments when compared with the normal pediatric population.
Level III-Therapeutic study.
关于接受先天性手部畸形手术重建的儿童的预后数据很少被使用或根本未被使用。一些外科医生甚至认为，手指或手部完全缺失的儿童功能完全正常。因此，本研究的目的是评估和比较接受显微外科脚趾到手部移植以重建先天性和创伤性手部畸形的儿童与正常儿童群体的功能预后。
使用儿科预后数据收集工具（PODCI）调查对总共10名青少年以及15名接受显微外科脚趾到手部移植的儿科和青少年患者的父母进行了评估。调查问卷在常规门诊就诊时发放或通过邮寄发放。对适应症和诊断与从调查中获得的功能预后进行了分析。将脚趾移植患者组的得分与正常儿童群体的得分以及患者和家长报告的影响进行了比较。
在3个调查小组和6个功能维度中，18个组中的13个组（72%）中，脚趾移植儿童与正常儿童群体在功能上没有统计学上的显著差异。青少年脚趾移植患者报告上肢功能、转移/基本活动能力下降，青少年的父母报告上肢功能、运动/身体功能和整体功能下降。父母在运动/身体功能和幸福感方面显著低估了他们青春期孩子的功能。脚趾到手部移植的先天性或创伤性适应症之间的得分没有显著差异。
接受显微外科脚趾到手部移植重建的先天性或创伤性手指缺失或发育不全的儿童在功能、感觉和日常活动能力方面可以取得显著改善。本研究证实，与正常儿童群体相比，接受显微外科脚趾到手部移植重建的儿童中有很大比例的功能预后评估相似。
三级治疗性研究。
