Kamarul Tunku, Mansor Azura, Robson Noorzurani, Albusaidi Salim Hh, Suhaeb Abdulrazzaq M, Samsudin Ely Z
1 National Orthopaedic Centre of Excellence for Research and Learning, Department of Orthopaedics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
2 Clinical Investigation Centre, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
J Orthop Surg (Hong Kong). 2018 Jan-Apr;26(1):2309499017749983. doi: 10.1177/2309499017749983.
Worldwide advances in microsurgery have made salvaging of amputated hand via replantation and revascularization common procedures. The present study examines the outcome of these procedures in a tertiary hospital in Malaysia.
Patients with hand amputation who underwent replantation or revascularization from 2005 to 2012 were identified and reviewed for patient characteristics, amputation characteristics and survival rates. Successfully treated patients were interviewed to assess the functional outcome using Quick Disability of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and Michigan Hand Outcome Questionnaire (MHQ). Statistical analysis was performed to evaluate outcome and elicit predictive factors.
Fifty-five patients were enrolled: 37 (67.3%) underwent replantation and 18 (32.7%) underwent revascularization. The overall success rate of 78% ( n = 43) was within the range of previously reported data (61.6% to 96.0%). Ischaemic time <6 h provided significantly better survival rates ( p < 0.05). Functional outcomes were successfully assessed in 34 patients (79%), at a mean follow-up of 40 months (range 11-93 months). The overall Quick-DASH and MHQ scores were 42.82 ± 23.69 and 60.94 ± 12.82, respectively. No previous reports of functional outcome were available for comparison. Both Quick-DASH ( p = 0.001) and MHQ scores ( p < 0.001) were significantly higher for finger injuries, followed by thumb, wrist and palm injuries.
Ischaemic time and level of injury are important predictors of success rate of replantation and revascularization of amputated upper limb appendages.
显微外科技术在全球范围内的进步使通过再植和血管重建挽救断肢成为常见手术。本研究探讨了马来西亚一家三级医院中这些手术的结果。
确定并回顾了2005年至2012年期间接受再植或血管重建的断肢患者的患者特征、截肢特征和存活率。对成功治疗的患者进行访谈，使用手臂、肩部和手部快速残疾问卷（Quick-DASH）和密歇根手部结果问卷（MHQ）评估功能结果。进行统计分析以评估结果并找出预测因素。
共纳入55例患者：37例（67.3%）接受了再植，18例（32.7%）接受了血管重建。总体成功率为78%（n = 43），在先前报告的数据范围内（61.6%至96.0%）。缺血时间<6小时的存活率明显更高（p < 0.05）。34例患者（79%）成功评估了功能结果，平均随访40个月（范围11 - 93个月）。Quick-DASH和MHQ的总体得分分别为42.82±23.69和60.94±12.82。此前没有关于功能结果的报告可供比较。手指损伤的Quick-DASH（p = 0.001）和MHQ得分（p < 0.001）均显著高于拇指、腕部和手掌损伤。
缺血时间和损伤程度是上肢断肢再植和血管重建成功率的重要预测因素。
