Franzblau Lauren E, Liang Xuebing, Wang Keming, Li Zhanguo, Li Yingni, Shauver Melissa, Chung Kevin C
University of Michigan Medical School, Ann Arbor, Mich. (L.E.F.); Plastic Surgery Hospital and 17th Department of Plastic Surgery, Plastic Surgery Hospital (K.W.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (X.L.); Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China (Z.L., Y.L.); and Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich. (M.S., K.C.C.).
Plast Reconstr Surg Glob Open. 2016 Nov 23;4(11):e1126. doi: 10.1097/GOX.0000000000001126. eCollection 2016 Nov.
China has a similar rheumatoid arthritis (RA) disease burden compared with other countries, yet RA patients rarely receive surgical treatment for hand deformities that limit function and impact appearance. We investigated potential barriers to rheumatoid hand surgery in China.
Patients with RA, rheumatologists, and hand surgeons at 3 large tertiary hospitals in Beijing completed questionnaires that assess knowledge and attitudes surrounding RA hand surgery. We calculated descriptive statistics and compared responses among groups using chi-square and Fisher exact tests as appropriate.
One hundred RA patients with hand deformities and 94 physicians completed the surveys. No patients had received hand surgery, and just 13% were aware of this treatment option. Patients and physicians most frequently cited uncertain effectiveness of surgery, high cost, and risk of surgical complications as potential barriers to hand reconstruction. Rheumatologists reported low rates of referral to hand surgeons (39% referred <5% of the time and 31% never referred). Most hand surgeons (69%) had not performed metacarpophalangeal arthroplasty, a common procedure for RA hand deformities, within the past year. Some had never performed this operation.
This survey revealed multiple barriers that support previous observations of infrequent reconstruction of RA hand deformities in China. These obstacles can be addressed through patient education, coordination between specialists, and more robust hand surgeon training in common RA procedures through the application of international plastic surgery collaborations.
与其他国家相比，中国类风湿关节炎（RA）的疾病负担相似，但RA患者很少因手部畸形接受手术治疗，这些畸形会限制功能并影响外观。我们调查了中国类风湿手部手术的潜在障碍。
北京3家大型三级医院的RA患者、风湿病学家和手外科医生完成了问卷，以评估围绕RA手部手术的知识和态度。我们计算了描述性统计数据，并根据情况使用卡方检验和Fisher精确检验比较了各组的回答。
100名有手部畸形的RA患者和94名医生完成了调查。没有患者接受过手部手术，只有13%的人知道这种治疗选择。患者和医生最常提到手术效果不确定、成本高以及手术并发症风险是手部重建的潜在障碍。风湿病学家报告称，转诊到手外科医生的比例较低（39%的人转诊时间<5%，31%的人从未转诊）。大多数手外科医生（69%）在过去一年中没有进行过掌指关节置换术，这是治疗RA手部畸形的常见手术。有些人从未做过这种手术。
这项调查揭示了多个障碍，支持了之前关于中国RA手部畸形重建不常见的观察结果。这些障碍可以通过患者教育、专家之间的协调以及通过国际整形外科学合作对常见RA手术进行更有力的手外科医生培训来解决。
