Yamamoto Michiro, Chung Kevin C, Sterbenz Jennifer, Shauver Melissa J, Tanaka Hirotaka, Nakamura Takashi, Oba Jumpei, Chin Takaaki, Hirata Hitoshi
Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.
Plast Reconstr Surg Glob Open. 2019 May 24;7(5):e2205. doi: 10.1097/GOX.0000000000002205. eCollection 2019 May.
This multicenter study aimed to examine the reasons for prosthesis rejection and assess the quality of life (QOL) among patients with upper limb deficiency.
Three rehabilitation centers in Japan and 1 academic medical center in the United States participated. Patients between the age of 12 and 75 years with unilateral or bilateral upper limb absence from the level of wrist to shoulder disarticulation were included. Two questionnaires were used, an original questionnaire on prosthesis use and the EQ-5D, which were completed by both the participant and a live-in proxy.
Of the 367 patients with upper limb loss invited, 174 patients participated in this study. Eighty percent of the study population were male patients. The most common amputation level was transradial. Trauma was the most common cause of limb loss. The prosthesis rejection rate was 9% (n = 16). The most common reason for abandonment was a lack of prosthesis functionality. Ten of 16 prosthesis nonusers (63%) and 59 prosthesis users (38%) were unemployed or students. The mean EQ-5D utility score was significantly higher in prosthesis users than in nonusers (0.762 versus 0.628, < 0.01). Live-in proxies significantly overestimated QOL in male patients (0.77 versus 0.807, =0.01).
The current prosthesis rejection rate is low. QOL was significantly higher in prosthesis users than in nonusers. More prosthesis users were employed compared with nonusers. Care should be taken not to overestimate the QOL of male patients with upper limb loss as their proxies often did.
这项多中心研究旨在探究上肢缺失患者假体排斥的原因，并评估其生活质量（QOL）。
日本的三个康复中心和美国的一个学术医疗中心参与了研究。纳入年龄在12至75岁之间、单侧或双侧上肢从腕部至肩关节离断缺失的患者。使用了两份问卷，一份是关于假体使用的原始问卷，另一份是EQ-5D问卷，由参与者及其同住的代理人完成。
在邀请的367例上肢缺失患者中，174例患者参与了本研究。研究人群中80%为男性患者。最常见的截肢水平是经桡骨截肢。创伤是肢体缺失最常见的原因。假体排斥率为9%（n = 16）。放弃使用假体最常见的原因是假体功能不足。16例未使用假体的患者中有10例（63%）以及59例使用假体的患者中有59例（38%）处于失业状态或为学生。假体使用者的平均EQ-5D效用评分显著高于未使用者（0.762对0.628，<0.01）。同住的代理人显著高估了男性患者的生活质量（0.77对0.807，=0.01）。
当前假体排斥率较低。假体使用者的生活质量显著高于未使用者。与未使用者相比，更多的假体使用者有工作。应注意避免像代理人常做的那样高估上肢缺失男性患者的生活质量。
