From the Division of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal; and Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.
Plast Reconstr Surg. 2022 Mar 1;149(3):465e-474e. doi: 10.1097/PRS.0000000000008846.
An amputation of the upper extremity not only is devastating for the patient's physical, emotional, and social well-being but also constitutes a financial stress for both the patient and the health care system. The objective of this study was to determine the utility and quality-adjusted life-years of hand allotransplantation versus myoelectric prostheses and to compare these measures in patients afflicted with unilateral versus bilateral amputations.
A survey was administered on bilateral amputees, unilateral amputees, replantation patients, and healthy controls. Patient demographics, functional patient-reported outcomes, quality-of-life questionnaires, and utility outcome measures were calculated for four different scenarios: hand transplantation and myoelectric prostheses with or without complications.
Five bilateral amputees, 12 unilateral amputees, nine replantation patients, and 45 healthy controls completed the survey. The highest quality-adjusted life-years were obtained in the replantation patient group for the scenario of myoelectric prosthesis without complications (mean, 34.8 years). Altogether, there was no statistically significant difference between hand transplantation and myoelectric prostheses (p = 0.36). On subgroup analysis, unilateral amputees reported significantly higher quality-adjusted life-years for myoelectric prostheses rather than hand transplantation (6.4; p = 0.0015), whereas bilateral amputees did not demonstrate a significant difference (-2.4; p = 0.299).
Utility and quality-adjusted life-years do not differ significantly between hand transplantation and myoelectric prostheses, except in unilateral amputees with myoelectric prostheses, who had higher quality-of-life scores. Based on trends from this pilot study, myoelectric prostheses may be considered for unilateral amputees, whereas no superiority can be demonstrated between both treatments in bilateral amputees.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
上肢截肢不仅对患者的身体、情感和社会福祉造成毁灭性影响，而且给患者和医疗保健系统带来经济压力。本研究的目的是确定手部同种异体移植与肌电假肢的效用和质量调整生命年，并比较单侧和双侧截肢患者的这些指标。
对双侧截肢者、单侧截肢者、再植患者和健康对照者进行了调查。计算了四种不同情况下的患者人口统计学、功能患者报告结果、生活质量问卷和效用结果测量：手部移植和带或不带并发症的肌电假肢。
5 名双侧截肢者、12 名单侧截肢者、9 名再植患者和 45 名健康对照者完成了调查。再植患者组在无并发症的肌电假肢方案中获得了最高的质量调整生命年（平均为 34.8 年）。总体而言，手部移植和肌电假肢之间没有统计学上的显著差异（p = 0.36）。在亚组分析中，单侧截肢者报告肌电假肢而非手部移植的质量调整生命年显著更高（6.4；p = 0.0015），而双侧截肢者则没有显著差异（-2.4；p = 0.299）。
除了使用肌电假肢的单侧截肢者外，手部移植和肌电假肢的效用和质量调整生命年没有显著差异，他们的生活质量评分更高。基于这项初步研究的趋势，肌电假肢可能被认为适用于单侧截肢者，而在双侧截肢者中，两种治疗方法之间没有表现出优越性。
临床问题/证据水平：治疗性，III 级。
