Rosberg Hans-Eric
Department of Clinical Sciences Malmö - Hand Surgery, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden.
BMC Musculoskelet Disord. 2014 Mar 10;15:73. doi: 10.1186/1471-2474-15-73.
Replantation in the upper extremity is a well-established microsurgical procedure. Many have reported patients' satisfaction and functional measurements.The aim was to investigate the long time consequences as activity limitations in hand/arm, the general health and cold sensitivity after a replantation or revascularization in the upper extremity and to examine if sense of coherence (SOC) can be an indicator for rehabilitation focus.
Between 1994-2008, 326 patients needed replantation/revascularization in the upper extremity. 297 patients were followed up. Information was collected from the medical notes and by questionnaires [Quick-DASH (disability hand/arm), EuroQ-5D (general health), CISS (cold sensitivity) and SOC (sense of coherence)]. Severity of injury was classified with the modified Hand Injury Severity Score (MHISS).
The patients [272 (84%) men and 54 (16%) women; median age 39 years (1-81 years)], where most injuries affected fingers (63%) and thumb (25%), commonly affecting the proximal phalanx (43%). The injuries were commonly related to saws (22%), machines (20%) and wood splints (20%). A direct anastomosis (30%) or vein grafts (70%) were used. The overall survival was 90%. 59% were classified as Major.Equal parts of the injuries took part during work and leisure, DASH scores at follow up were worse (p = 0.005) in the former. Twenty percent changed work and 10% retired early. Patients with early retirement were significantly older, had a more severe injury, worse disability, quality of life and functional outcome. Median DASH score was low [11.4 (0-88.6)] and correlated with severity of injury. Abnormal cold sensitivity (CISS > 50) was seen in 51/209 (24%) and they had a worse disability, quality of life, functional outcome and lower SOC. Patients with a low SOC had on the whole a worse outcome compared to patients with a high SOC and with significant differences in age, EQ-5D, Quick-DASH and CISS.
A high MHISS, abnormal cold intolerance and a low SOC seems to be factors influencing the patients' outcome and might be relevant in the rehabilitation of the patients. Also, those who had to retire early had a worse disability, quality of life and functional outcome.
上肢再植是一种成熟的显微外科手术。许多人报告了患者的满意度和功能测量结果。目的是调查上肢再植或血管重建术后手部/手臂活动受限、总体健康状况和冷敏感性的长期后果，并检查连贯感（SOC）是否可作为康复重点的指标。
1994年至2008年间，326例患者需要进行上肢再植/血管重建。对297例患者进行了随访。从病历和问卷调查中收集信息[快速DASH（手部/手臂残疾）、欧洲五维健康量表（总体健康）、CISS（冷敏感性）和SOC（连贯感）]。采用改良手部损伤严重程度评分（MHISS）对损伤严重程度进行分类。
患者[272例（84%）男性和54例（16%）女性；中位年龄39岁（1 - 81岁）]，大多数损伤累及手指（63%）和拇指（25%），常见于近端指骨（43%）。损伤通常与锯（22%）、机器（20%）和木片（20%）有关。采用直接吻合（30%）或静脉移植（70%）。总体存活率为90%。59%被分类为重伤。工作和休闲期间受伤的比例相同，随访时工作期间受伤患者的DASH评分更差（p = 0.005）。20%的人更换了工作，10%的人提前退休。提前退休的患者年龄明显更大，损伤更严重，残疾、生活质量和功能结局更差。DASH评分中位数较低[11.4（0 - 88.6）]，且与损伤严重程度相关。51/209例（24%）出现异常冷敏感性（CISS > 50），他们的残疾、生活质量、功能结局更差，SOC更低。与高SOC患者相比，低SOC患者总体结局更差，在年龄、EQ - 5D、快速DASH和CISS方面存在显著差异。
高MHISS、异常冷不耐受和低SOC似乎是影响患者结局的因素，可能与患者的康复有关。此外，那些不得不提前退休的患者残疾、生活质量和功能结局更差。
