Chen Jing, Zhang Ai Xian, Chen Qing Zhong, Mu Shuai, Tan Jun
Department of Medical Research Center of Jiangsu Province, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
Department of Internal Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
Acta Orthop Traumatol Turc. 2018 Mar;52(2):120-126. doi: 10.1016/j.aott.2017.09.001. Epub 2018 Feb 14.
The aim of this study was to analyse the long-term functional, subjective, and psychological results after single-digit replantation.
Thirty cases of digital replantation (14 thumbs, 12 index fingers, 2 middle fingers, 1 ring finger, and 1 little finger) in 30 patients (7 females and 23 males) with a mean age of 44.2 years (20-65 years) were evaluated at the end of a mean follow-up time of 36 months (19-50 months). The active range of motion of joints, grip and pinch strength, cutaneous sensibility, upper-extremity functioning, and subjective satisfaction were determined using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes questionnaire (MHQ). Psychological sequelae, including depression, anxiety, and posttraumatic stress disorder (PTSD), were assessed. A correlation analysis among variables was also performed.
The mean score for the DASH questionnaire was 6.6 (range: 0-39.2). The symptom of cold intolerance occurred in 53% of the patients. Two patients were diagnosed with depression, and only one patient exhibited PTSD. The DASH score had a good statistical correlation with total grip strength, pinch grip strength, and static two-point discrimination (S-2PD) (P < 0.05). Several aspects of the MHQ were also statistically relevant to some or all of the three objective results. Furthermore, the grip strength showed significant correlation with DASH and most aspects of the MHQ in multivariate logistic regression analysis (P < 0.05).
Total grip strength is the most important factor positively related to subjective outcomes. The incidence rates of psychological symptoms after digit replantation are very low at long-term follow-up.
Level IV, therapeutic study.
本研究旨在分析单指再植术后的长期功能、主观感受及心理方面的结果。
对30例患者（7例女性，23例男性）的30例手指再植病例（14例拇指、12例示指、2例中指、1例环指和1例小指）进行评估，患者平均年龄44.2岁（20 - 65岁），平均随访时间为36个月（19 - 50个月）。使用手臂、肩部和手部功能障碍（DASH）问卷及密歇根手部结果问卷（MHQ）确定关节的主动活动范围、握力和捏力、皮肤感觉、上肢功能及主观满意度。评估包括抑郁、焦虑和创伤后应激障碍（PTSD）在内的心理后遗症。还对各变量进行了相关性分析。
DASH问卷的平均得分为6.6（范围：0 - 39.2）。53%的患者出现不耐寒症状。2例患者被诊断为抑郁，仅1例患者表现出创伤后应激障碍。DASH评分与总握力、捏力及静态两点辨别觉（S - 2PD）具有良好的统计学相关性（P < 0.05）。MHQ的几个方面在统计学上也与这三个客观结果中的部分或全部相关。此外，在多因素逻辑回归分析中，握力与DASH及MHQ的大多数方面显示出显著相关性（P < 0.05）。
总握力是与主观结果呈正相关的最重要因素。手指再植术后长期随访时心理症状的发生率非常低。
四级，治疗性研究。
