Bhat Anil K, Acharya A M, Mishra Deepankar
Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal University, India.
J Clin Orthop Trauma. 2020 Jul-Aug;11(4):620-625. doi: 10.1016/j.jcot.2020.05.026. Epub 2020 Jun 17.
The widely used Hand Injury Severity Score (HISS) has intrinsic drawbacks like inability to score vascular status and questionable correlation with Disability of Arm, shoulder and Hand. We compared it with the Strickland score which is easier to calculate and has provision for evaluation of vascular status. We assessed correlation of both the scores with the Michigan Hand Outcome Questionnaire (MHQ).
In a prospective study of 1574 patients admitted with hand injuries, we recorded their HISS and Strickland scores and followed them up for a year and later interviewed for MHQ score. Statistical correlation was done comparing the HISS and Strickland score with the MHQ using the SPSS package.
Majority of these injuries were in manual labourers (47.5%) with agricultural or industrial background with a mean age of 25 years (18-26 years). Using the One-way ANOVA test we found a significant correlation between the HISS and MHQ (P Value < 0.001). Using the Unpaired T-test, statistically significant association (P < 0.001) was seen between the Strickland score and MHQ. The correlation between HISS and Strickland Score done by One-way ANOVA Test was also found to be significant (P Value < 0.001). On evaluating the group of patients with a Strickland score >10, we observed that the MHQ was almost similar between those who underwent amputation with those who underwent a successful salvage, though not statistically significant.
HISS and Strickland score correlated significantly with each other and with the MHQ. Strickland score was easy and quicker to determine the salvagability of hand injury. However, small group of patients who may benefit from salvage in spite of a high Strickland score where factors like patient's age, occupation, comorbid health condition, motivation, expenses, and social environment needs to be taken into account in decision making.
广泛使用的手损伤严重程度评分（HISS）存在内在缺陷，如无法对手部血管状况进行评分，且与上肢、肩部和手部功能障碍的相关性存疑。我们将其与计算更简便且能评估血管状况的斯特里克兰德评分进行了比较。我们评估了这两种评分与密歇根手功能结果问卷（MHQ）的相关性。
在一项对1574例手部损伤住院患者的前瞻性研究中，我们记录了他们的HISS和斯特里克兰德评分，并对他们进行了为期一年的随访，之后对其进行访谈以获取MHQ评分。使用SPSS软件包对HISS和斯特里克兰德评分与MHQ进行统计相关性分析。
这些损伤的大多数患者为体力劳动者（47.5%），具有农业或工业背景，平均年龄为25岁（18 - 26岁）。使用单因素方差分析，我们发现HISS与MHQ之间存在显著相关性（P值<0.001）。使用非配对t检验，斯特里克兰德评分与MHQ之间也存在统计学上的显著关联（P<0.001）。通过单因素方差分析得出的HISS与斯特里克兰德评分之间的相关性也具有显著性（P值<0.001）。在评估斯特里克兰德评分>10的患者组时，我们观察到接受截肢的患者与成功保肢的患者的MHQ评分几乎相似，尽管无统计学意义。
HISS和斯特里克兰德评分相互之间以及与MHQ均存在显著相关性。斯特里克兰德评分在确定手部损伤的保肢可能性方面简便快捷。然而，对于一小部分尽管斯特里克兰德评分较高但仍可能从保肢中获益的患者，在决策时需要考虑患者的年龄、职业、合并健康状况、动机、费用以及社会环境等因素。
