Service de chirurgie plastique, reconstructrice et esthétique - brûlés - chirurgie de la main, CHU de Bordeaux, groupe hospitalier Pellegrin, centre François-Xavier Michelet, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
Department of Plastic, Reconstructive, and Aesthetic Surgery, Hôpital Sud, Rennes, France.
Hand Surg Rehabil. 2020 Apr;39(2):125-130. doi: 10.1016/j.hansur.2019.11.007. Epub 2019 Dec 19.
Amputation of the second ray is a surgical treatment option when reconstruction and/or reimplantation fail. The aim of our study was to review the outcomes after transmetacarpal resection of the second ray following a post-traumatic injury and to assess indications, functional outcomes, and patient satisfaction. Between January 2003 and December 2013, 25 patients (6 women and 19 men with a mean age of 51 years) underwent transmetacarpal resection of their second ray after a post-traumatic injury. Sixteen patients were right-handed and 9 were left-handed. Injuries involved the dominant hand in 14 cases (60%). In order to differentiate patients with preserved index finger length preoperatively from those with a shorter, amputated index finger stump, patients were divided into 2 groups. Group 1 included those with an "intact finger" and Group 2 included patients with an "amputated stump". Data collection, including patient satisfaction and functional outcomes, was performed at 83 months postoperative on average. Average length of follow-up was 7.0±1.0 years (range 5-12 years). Group 1 (intact finger) and 2 (amputated stump) included 15 and 10 patients, respectively. Six patients (24%) had primary ray amputation and 19 (76%) had secondary ray amputation. No surgical revision was necessary. In Group 1, the indications were purely functional in all but two cases, whereas aesthetic indications played a role in all patients in Group 2. The average total time off work was 3 months. There was no difference between Group 1 and 2 (P>0.05). However, patients with primary ray resection averaged 10 weeks of lost work compared to 17 weeks for secondary amputation. There was no functional difference between Groups 1 and 2. Scores for cosmetic appearance and patient satisfaction were higher in Group 2. In certain specific situations after complex hand trauma, transmetacarpal amputation of the second ray is indicated as soon as possible, in order to reduce the time off work. Patient satisfaction following this surgical procedure is high, especially in groups with amputated stumps. A 30% decrease in pinch and grip strength is the rule. No secondary surgery is normally required.
第二掌骨切除是一种治疗重建和/或再植入失败后的手术选择。我们的研究旨在回顾创伤后第二掌骨经掌骨切除的治疗结果，并评估其适应证、功能结果和患者满意度。2003 年 1 月至 2013 年 12 月，25 例（6 名女性和 19 名男性，平均年龄 51 岁）创伤后患者接受了第二掌骨经掌骨切除。16 名患者为右利手，9 名患者为左利手。损伤涉及优势手 14 例（60%）。为了区分术前食指长度保留的患者和食指短缩、截肢残端的患者，将患者分为 2 组。第 1 组包括“完整手指”患者，第 2 组包括“截肢残端”患者。术后 83 个月平均进行了 83 个月的患者满意度和功能结果数据采集。平均随访时间为 7.0±1.0 年（5-12 年）。第 1 组（完整手指）和第 2 组（截肢残端）分别包括 15 例和 10 例患者。6 例（24%）患者行主骨截肢，19 例（76%）患者行次骨截肢。无手术修正。在第 1 组中，除了 2 例外，所有患者的适应证均为纯功能性，而第 2 组中所有患者的适应证均为美观性。平均停工时间为 3 个月。第 1 组和第 2 组之间无差异（P＞0.05）。然而，主骨切除患者平均停工 10 周，而次骨截肢患者停工 17 周。第 1 组和第 2 组之间无功能差异。第 2 组患者的美容外观和患者满意度评分较高。在复杂手部创伤后某些特定情况下，尽早进行第二掌骨经掌骨切除是必要的，以减少停工时间。患者对这种手术方法的满意度较高，尤其是在截肢残端的患者中。握力和捏力减少 30%是正常的。通常不需要进行二次手术。
