Yano Koichi, Kaneshiro Yasunori, Hyun Seungho, Sakanaka Hideki
Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai-ku, Sakai City, Osaka, Japan.
J Hand Microsurg. 2022 Feb 15;15(4):289-294. doi: 10.1055/s-0042-1742664. eCollection 2023 Sep.
The clinical results of replantation for an amputated distal finger are functionally acceptable. However, few reports exist regarding sequential clinical postoperative recovery. The purpose of this study was to examine the clinical recovery at every 3 months up to 1 year postoperatively. Nineteen patients (16 patients were men), representing 19 fingers with complete amputation at Tamai's zone 1 and replanted successfully, were included in this study. Total active motion (TAM), grip strength (GS), Semmes-Weinstein monofilament (SW) test result, static two-point discrimination (s2PD), and Disability of the Arm, Shoulder, and Hand (DASH) score questionnaire results were obtained postoperatively at 3, 6, 9, and 12 months. Pulp atrophy and nail deformity were assessed at 12 months postoperatively. The postoperative %TAM (compared to the uninjured side, 81.8 ± 18.1 at 3 months vs. 91.5 ± 11.9 at 6 months, < 0.01), %GS (compared with the uninjured side, 61.3 ± 25.9 at 3 months vs. 78.3 ± 20.4 at 6 months, = 0.02), s2PD (excellent and good/poor; 7/12 at 3 months vs. 18/1 at 6 months, < 0.01), and DASH scores (26.1 ± 23.1 at 3 months vs. 12.0 ± 12.9 at 6 months, < 0.01) recovered significantly from 3 to 6 months but did not change significantly from 6 months onward. The SW test results showed a significant recovery between 3 and 12 months postoperatively (2.83 and 3.61/4.31, 6.65, and undetectable, 1/18 at 3 months vs. 7/12 at 12 months, = 0.04). The DASH score at 12 months postoperatively was significantly associated with %TAM ( = -0.64, < 0.01) and %GS ( = -0.58, < 0.01) at 12 months postoperatively and age ( = 0.52, = 0.02). Five fingers had pulp atrophy and four fingers had nail deformity. This 1-year follow-up study showed the sequential clinical recovery after replantation for complete amputation in Tamai zone 1. Postoperative %TAM, %GS, and the DASH score recovered significantly between 3 and 6 months but significant recovery up to 1 year was not observed.
断指再植的临床结果在功能上是可以接受的。然而，关于术后连续临床恢复情况的报道较少。本研究的目的是观察术后1年内每3个月的临床恢复情况。
本研究纳入了19例患者（16例男性），共19根手指，均为在玉井1区完全离断并成功再植。术后3、6、9和12个月时，分别获取总主动活动度（TAM）、握力（GS）、Semmes-Weinstein单丝（SW）试验结果、静态两点辨别觉（s2PD）以及上肢、肩部和手部功能障碍（DASH）评分问卷结果。术后12个月时评估指腹萎缩和指甲畸形情况。
术后3个月时的TAM百分比（与未受伤侧相比，3个月时为81.8±18.1，6个月时为91.5±11.9，P<0.01）、GS百分比（与未受伤侧相比，3个月时为61.3±25.9，6个月时为78.3±20.4，P=0.02）、s2PD（优和良/差；3个月时为7/12，6个月时为18/1，P<0.01）以及DASH评分（3个月时为26.1±23.1，6个月时为12.0±12.9，P<0.01）从3个月到6个月有显著恢复，但6个月后无显著变化。SW试验结果显示术后3个月至12个月有显著恢复（3个月时为2.83和3.61/4.31、6.65，无法检测，1/18，12个月时为7/12，P=0.04）。术后12个月时的DASH评分与术后12个月时的TAM百分比（P=-0.64，P<0.01）、GS百分比（P=-0.58，P<0.01）以及年龄（P=0.52，P=0.02）显著相关。5根手指出现指腹萎缩，4根手指出现指甲畸形。
这项为期1年的随访研究显示了玉井1区完全离断再植术后的连续临床恢复情况。术后TAM百分比、GS百分比和DASH评分在3至6个月时有显著恢复，但直至1年时未观察到显著恢复。
