Nakanishi Akito, Omokawa Shohei, Kawamura Kenji, Iida Akio, Kaji Daisuke, Tanaka Yasuhito
Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.
Department of Hand Surgery, Nara Medical University, Nara, Japan.
J Hand Surg Am. 2019 Aug;44(8):655-661. doi: 10.1016/j.jhsa.2019.03.016. Epub 2019 May 10.
The surgical treatment of fingertip amputations is controversial. This study was designed to compare the clinical results of 2 surgical procedures for fingertip amputation: reconstruction with a digital artery flap and microsurgical replantation.
Between 2003 and 2015, 37 patients with Tamai zone 1 fingertip amputation of the index or middle finger were treated by reconstruction with a digital artery flap (n = 23) or microsurgical replantation (n = 14). Data for these patients were evaluated retrospectively. Nerve suture was not conducted in microsurgical replantation because spontaneous sensory recovery is expected in zone 1 replantation. Primary outcomes included hand dexterity (Purdue Pegboard Test), and disability of the upper extremity (Disabilities of the Arm, Shoulder, and Hand score). Secondary outcomes included strength (key pinch), digital sensitivity (Semmes-Weinstein test), and finger mobility (% total active motion).
The average follow-up period was 34 months. There was no significant difference in the primary outcomes between the 2 groups. The reconstruction group showed significantly better results for the secondary outcomes.
This study suggests that the 2 procedures were comparable regarding postoperative activities of daily living and hand performance, but reconstruction using a digital artery flap gave better objective functional outcomes than microsurgical replantation.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
指尖离断伤的手术治疗存在争议。本研究旨在比较两种指尖离断伤手术方法的临床效果：指动脉皮瓣重建术和显微再植术。
2003年至2015年期间，37例示指或中指Tamai 1区指尖离断伤患者接受了指动脉皮瓣重建术（n = 23）或显微再植术（n = 14）治疗。对这些患者的数据进行回顾性评估。显微再植术中未进行神经缝合，因为预计1区再植术可实现自发感觉恢复。主要结局指标包括手部灵巧性（普渡钉板试验）和上肢功能障碍（手臂、肩部和手部功能障碍评分）。次要结局指标包括力量（捏力）、手指感觉（Semmes-Weinstein试验）和手指活动度（总主动活动百分比）。
平均随访期为34个月。两组的主要结局指标无显著差异。重建组的次要结局指标结果明显更好。
本研究表明，两种手术方法在术后日常生活活动和手部功能方面具有可比性，但指动脉皮瓣重建术比显微再植术具有更好的客观功能结局。
研究类型/证据水平：治疗性IV级。
