Nakanishi Akito, Omokawa Shohei, Iida Akio, Kaji Daisuke, Tanaka Yasuhito
Department of Orthopaedic Surgery, Takita Hospital, Nara, Japan.
Department of Hand Surgery, Nara Medical University, Nara, Japan.
J Hand Surg Am. 2015 Nov;40(11):2155-9. doi: 10.1016/j.jhsa.2015.08.008. Epub 2015 Sep 26.
To identify independent predictors of postoperative proximal interphalangeal (PIP) joint contracture after direct-flow homodigital island flap transfer.
Forty-four fingertip amputations in 39 patients treated with oblique triangular flaps were evaluated at a minimum of 1 year after surgery. Five variables were examined: patient age, injured finger, mechanism of injury, flap advancement distance, and time required for wound healing. Univariate and multivariate linear regression analyses were performed to identify the extent to which these variables affected the flexion contracture of the PIP joint.
The average reduction in the passive extension angle of the PIP joint was 16° at final follow-up. Univariate analysis indicated significant correlations of PIP joint flexion contracture with age, injured finger, and time for wound healing, but no significant correlation with the distance the flap was advanced. Multivariate analysis indicated that the age and duration of wound healing were independent predictors of the flexion contracture of the PIP joint.
Elderly people and cases with delayed wound healing are at risk for postoperative PIP joint contracture after homodigital flap transfer. Intervention with early hand therapy and orthotics may be useful in elderly patients with delayed wound healing.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
确定顺血流同指岛状皮瓣转移术后近端指间（PIP）关节挛缩的独立预测因素。
对39例采用斜三角形皮瓣治疗的44例指尖离断患者进行了至少术后1年的评估。检查了五个变量：患者年龄、受伤手指、损伤机制、皮瓣推进距离和伤口愈合所需时间。进行单因素和多因素线性回归分析，以确定这些变量对PIP关节屈曲挛缩的影响程度。
末次随访时，PIP关节被动伸展角度平均减小16°。单因素分析表明，PIP关节屈曲挛缩与年龄、受伤手指和伤口愈合时间显著相关，但与皮瓣推进距离无显著相关性。多因素分析表明，年龄和伤口愈合持续时间是PIP关节屈曲挛缩的独立预测因素。
老年人和伤口愈合延迟的患者在同指皮瓣转移术后有发生PIP关节挛缩的风险。对伤口愈合延迟的老年患者，早期手部治疗和矫形器干预可能有用。
研究类型/证据水平：预后性研究II级
