Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth, People's Hospital, Shanghai, 200233, China.
Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth, People's Hospital, Shanghai, 200233, China; Institute of Microsurgery on Extremities, Shanghai Jiaotong University Affiliated Sixth, People's Hospital, Shanghai, 200233, China.
Int J Surg. 2019 Sep;69:84-88. doi: 10.1016/j.ijsu.2019.07.027. Epub 2019 Jul 27.
Previous studies have demonstrated that age, smoking, Tamai's level of amputation, causes of injury and ischemia time were associated with the success rate of digit replantation. The primary objective of this study is to investigate whether mental status including anxiety and depression is associated with the rate of digit replant failure.
This study included 134 digits from 102 patients who received digital replantation after complete amputation from 1 September 2013 to 1 September 2015. The Zung self-rating anxiety scale (SAS) and the Zung self-rating depression scale (SDS) were used to assess the pre-injury level of anxiety and depression for each patient. All participants were followed up for at least 1 month. Failure was defined as necrosis of replanted finger which required revision amputation or flap cover of the skeleton.
Multivariate logistic regression analysis showed that increased level of pre-injury anxiety was an independent risk factor correlated with success rate (odds ratios [OR] = 7.69, 95% confidence interval [CI]: 1.93-30.30) in this series. The relative risk of anxiety group was 4.48 (95% CI: 1.38-14.49) compared to normal group. Digits with double arterial anastomosis in anxiety patients showed a higher survival rate while the number of veins repaired showed no significant effect on survival rate.
Increased level of pre-injury anxiety was an independent risk factors for digit replantation failure. Double arterial anastomosis increased the success rate of replanted digits in anxiety patients.
先前的研究表明，年龄、吸烟、断指平面、受伤原因和缺血时间与断指再植成功率有关。本研究的主要目的是探讨精神状态（包括焦虑和抑郁）是否与断指再植失败率有关。
本研究纳入了 2013 年 9 月 1 日至 2015 年 9 月 1 日期间因完全离断而接受断指再植的 102 例患者的 134 个断指。采用zung 自评焦虑量表（SAS）和 zung 自评抑郁量表（SDS）评估每位患者受伤前的焦虑和抑郁水平。所有患者均至少随访 1 个月。失败定义为再植手指坏死，需要 Revision 截肢或皮瓣覆盖骨骼。
多因素 logistic 回归分析显示，受伤前焦虑水平升高是与本系列成功率相关的独立危险因素（优势比[OR] = 7.69，95%置信区间[CI]：1.93-30.30）。焦虑组的相对危险度为 4.48（95%CI：1.38-14.49），与正常组相比。焦虑患者的双动脉吻合术可提高再植手指的成活率，而修复的静脉数量对成活率无显著影响。
受伤前焦虑水平升高是断指再植失败的独立危险因素。双动脉吻合术可提高焦虑患者再植手指的成活率。
