Assouline U, Feuvrier D, Lepage D, Tropet Y, Obert L, Pauchot J
Service de chirurgie orthopédique, traumatologique, chirurgie plastique, reconstructrice et assistance main, CHRU Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France.
Service de chirurgie orthopédique, traumatologique, chirurgie plastique, reconstructrice et assistance main, CHRU Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France.
Hand Surg Rehabil. 2017 Sep;36(4):261-267. doi: 10.1016/j.hansur.2017.05.002. Epub 2017 Jun 12.
The aims of this study were to evaluate the function and quality of life in patients who have undergone replantation of the hand or forearm. We carried out a retrospective single-center study of cases performed between 1977 and 2015. Our hospital's database was searched for patients who underwent replantation of the distal half of the forearm and hand (except the fingers). The evaluation included sensitivity, joint mobility, strength and quality of life. Conventional functional scores were used. Seventeen replantation cases were identified. Four patients were lost to follow-up. Of the 13 available patients, two suffered a replantation failure. Ultimately 11 patients were included in the study. Three patients were evaluated based on their medical records and eight were reviewed in person. The mean patient age was 31±11.8 years. The sensory evaluation resulted in five patients being classified as S1 and one as S3+. The mean Kapandji score was 4.3±2.3 [0-6]. The mean grip strength was 39.4±20% [0-80], and the pinch strength was 36.2±16% [0-60] compared to the healthy contralateral side. The mean DASH was 36.2±30.4 [4.5-79.5]. According to Chen's classification, two patients were at stage IV. For 50% of patients, the overall quality of life was at least equivalent to that of the general population. Replantation of the distal half of the forearm and hand should be attempted whenever possible. Although replantation causes some disability, good quality of life seems to be maintained.
本研究的目的是评估接受手部或前臂再植手术患者的功能和生活质量。我们对1977年至2015年间进行的病例开展了一项回顾性单中心研究。在我院数据库中搜索接受前臂远端和手部（除手指外）再植手术的患者。评估内容包括感觉、关节活动度、力量和生活质量。采用传统功能评分。共确定了17例再植病例。4例患者失访。在13例可随访的患者中，2例再植失败。最终11例患者纳入研究。3例患者根据病历进行评估，8例患者进行了亲自复查。患者平均年龄为31±11.8岁。感觉评估结果为5例患者分类为S1，1例为S3+。平均Kapandji评分为4.3±2.3[0 - 6]。与对侧健康侧相比，平均握力为39.4±20%[0 - 80]，捏力为36.2±16%[0 - 60]。平均DASH评分为36.2±30.4[4.5 - 79.5]。根据陈式分类，2例患者处于IV期。50%的患者总体生活质量至少与普通人群相当。只要有可能，应尝试进行前臂远端和手部的再植手术。虽然再植会导致一些残疾，但似乎能维持较好的生活质量。
