Matsumoto Márcio Koji, Fernandes Marcela, de Moraes Vinícius Ynoe, Raduan Jorge, Okamura Aldo, Belloti João Carlos
Department of Hand Surgery Residency, Hospital Alvorada, São Paulo, SP, Brazil.
Acta Ortop Bras. 2018;26(5):294-299. doi: 10.1590/1413-785220182604187738.
To verify if there is consensus about the treatment of each type of injury or amputation of the fingertips, and if there is a statistical difference among the treatment options according to the surgeon's length of time in the hand surgery specialty.
A cross-sectional survey was conducted during the 37th Brazilian Congress of Hand Surgery, when one hundred and twenty questionnaires were randomly distributed. Observing the inclusion and exclusion criteria, ninety completed questionnaires were included. The answers were submitted to descriptive and inferential analysis with a significance level of p <0.05.
This study showed agreement of 63.3% for the treatment with statistical difference for dorsal oblique injury less than 1 cm with bone exposure for the VY advancement flap alternative; 46.7% for volar tip oblique injury with bone exposure less than 1 cm for the Cross Finger alternative; 47.8% for oblique thumb volar injury greater than 1 cm with no bone exposure to the Moberg alternative; 54.4% for thumb pulp injury up to 2.5 cm with bone exposure to the Moberg alternative with proximal release, and 92.2% for antibiotic use, for the "cephalexin" alternative.
There is no consensus regarding the treatment of most types of fingertip lesions, with agreement of 45.4%. When we subdivided by time group of specialty in hand surgery, there was an increase in agreement to 54.5% of the questions per subgroup. Further comparative studies are needed to assess the consensus among surgeons regarding the treatment of fingertip injury.
验证对于每种类型的指尖损伤或截肢的治疗是否存在共识,以及根据外科医生在手外科专业的工作时长,各治疗方案之间是否存在统计学差异。
在第37届巴西手外科学会上进行了一项横断面调查,随机发放了120份问卷。根据纳入和排除标准,纳入了90份完整的问卷。对答案进行描述性和推断性分析,显著性水平为p<0.05。
本研究显示,对于VY推进皮瓣替代方案治疗背侧斜形损伤小于1cm且有骨质外露,有63.3%的人达成一致且存在统计学差异;对于交叉手指替代方案治疗掌侧指尖斜形损伤且骨质外露小于1cm,有46.7%的人达成一致;对于拇指掌侧斜形损伤大于1cm且无骨质外露采用莫伯格替代方案,有47.8%的人达成一致;对于拇指指腹损伤达2.5cm且有骨质外露采用近端松解的莫伯格替代方案,有54.4%的人达成一致;对于使用抗生素选择“头孢氨苄”,有92.2%的人达成一致。
对于大多数类型的指尖损伤的治疗不存在共识,达成一致的比例为45.4%。当我们按手外科专业工作时长分组细分时,每个亚组问题的达成一致率提高到了54.5%。需要进一步的比较研究来评估外科医生在指尖损伤治疗方面的共识。