Lee Jung Soo, Kim Yeo Hyung
Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Medicine (Baltimore). 2019 Jan;98(3):e14183. doi: 10.1097/MD.0000000000014183.
Hand injuries are common and have a significant impact on daily life. However, the factors associated with functional outcome after hand injuries are not well established. The purpose of this study was to identify factors that are independently associated with hand total active motion (TAM).A total of 50 patients with unilateral complex hand injury were included in this study. The associations between various demographic, injury-related, and clinical assessment factors and TAM were determined by univariate and multivariate linear regression analyses. Nerve injuries recognized during surgery and diagnosed with electrodiagnostic (EDX) studies were compared using Pearson chi-squared test.Among multiple injury-related and initial clinical assessment factors, nerve injury diagnosed with EDX studies, hospital stay length, elevated C-reactive protein, and skeletal injury were independently associated with TAM in the affected hand after adjusting for covariates. Nerve injuries diagnosed with EDX studies were not consistent with those recognized during surgery.Our results suggest that high-energy trauma leading to skeletal and nerve injury with inflammation is associated with limited hand motion after surgery and postoperative immobilization. A comprehensive EDX study may enable identifying occult or recovered nerve injuries, which would be helpful in understanding limitations in finger movements.
手部损伤很常见，对日常生活有重大影响。然而，手部损伤后与功能结局相关的因素尚未完全明确。本研究的目的是确定与手部总主动活动度（TAM）独立相关的因素。本研究共纳入50例单侧复杂性手部损伤患者。通过单因素和多因素线性回归分析确定各种人口统计学、损伤相关因素和临床评估因素与TAM之间的关联。使用Pearson卡方检验比较手术中识别并经电诊断（EDX）研究确诊的神经损伤。在多种损伤相关因素和初始临床评估因素中，经EDX研究确诊的神经损伤、住院时间、C反应蛋白升高和骨骼损伤在调整协变量后与患手的TAM独立相关。经EDX研究确诊的神经损伤与手术中识别的神经损伤不一致。我们的结果表明，导致骨骼和神经损伤并伴有炎症的高能创伤与术后及术后固定期间手部活动受限有关。全面的EDX研究可能有助于识别隐匿性或恢复性神经损伤，这有助于理解手指运动的局限性。
