Ferree Steven, van der Vliet Quirine M J, van Heijl Mark, Houwert Roderick M, Leenen Luke P H, Hietbrink Falco
Department of Surgery, University Medical Centre Utrecht, The Netherlands.
Utrecht Traumacenter, Utrecht, The Netherlands.
Injury. 2017 Apr;48(4):930-935. doi: 10.1016/j.injury.2017.02.034. Epub 2017 Mar 6.
Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence, distribution and functional outcome of fractures and dislocation of the hand in polytrauma patients.
A single centre retrospective cohort study was performed at a level 1 trauma centre. Polytrauma was defined as patients with an Injury Severity Score of 16 or higher. Fractures and dislocations to the hand were determined. All eligible polytrauma patients with hand injuries were included and a Quick Disability of Arm, Shoulder and Hand questionnaire (QDASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) were administered. Patients were contacted 1-6 years after trauma.
In a cohort of 2046 polytrauma patients 72 patients (3.5%) suffered a hand injury. The functional outcome scores of 52 patients (72%) were obtained. The Metacarpal (48%) and carpal (33%) bones were the most frequently affected. The median QDASH score for all patients with hand injury was 17 (IQR 0-31) and the PRWHE 14 (IQR 0-41). Patients with a concomitant upper extremity injury (p=0.002 for PRWHE, p0.006 for QDASH) and those with higher ISS scores (p=0.034 for PRWHE, QDASH not significant) had worse functional outcome scores. As an example, of the 5 patients with the worst outcome scores 3 suffered an isolated phalangeal injury, all had concomitant upper extremity injury or neurological injuries (3 plexus injuries, 1 severe brain injury).
The incidence of hand injuries in polytrauma patients is 3.5%, which is relatively low compared to a general trauma population. Metacarpal and carpal bones were most frequently affected. The functional extremity specific outcome scores are highly influenced by concomitant injuries (upper extremity injuries, neurological injuries and higher ISS).
手部损伤可导致严重的功能障碍、生活质量下降以及工作恢复延迟。然而，目前多发伤患者手部损伤的发生率及功能预后尚不清楚。本研究的目的是确定多发伤患者手部骨折和脱位的发生率、分布情况及功能预后。
在一家一级创伤中心进行了一项单中心回顾性队列研究。多发伤定义为损伤严重程度评分（ISS）为16分或更高的患者。确定手部骨折和脱位情况。纳入所有符合条件的手部受伤的多发伤患者，并进行手臂、肩部和手部快速残疾问卷（QDASH）以及患者自评手腕/手部评估（PRWHE）。在创伤后1 - 6年对患者进行随访。
在2046例多发伤患者队列中，72例（3.5%）手部受伤。获得了52例患者（72%）的功能预后评分。掌骨（48%）和腕骨（33%）是最常受累的部位。所有手部受伤患者的QDASH评分中位数为17（四分位间距0 - 31），PRWHE评分为14（四分位间距0 - 41）。伴有上肢损伤的患者（PRWHE，p = 0.002；QDASH，p = 0.006）以及ISS评分较高的患者（PRWHE，p = 0.034；QDASH无显著差异）功能预后评分较差。例如，在功能预后评分最差的5例患者中，3例为单纯指骨损伤，所有患者均伴有上肢损伤或神经损伤（3例臂丛神经损伤，1例严重脑损伤）。
多发伤患者手部损伤的发生率为3.5%，与一般创伤人群相比相对较低。掌骨和腕骨最常受累。特定肢体的功能预后评分受合并伤（上肢损伤、神经损伤和较高ISS）的影响很大。
