Pyörny Joonas, Sletten Ida Neergård, Jokihaara Jarkko
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
JB JS Open Access. 2024 Dec 3;9(4). doi: 10.2106/JBJS.OA.24.00098. eCollection 2024 Oct-Dec.
Microsurgical emergency revascularization surgery for traumatic upper-extremity amputations demands high resource use. Injury details and patient characteristics influence the decision of whether to revascularize or revise an amputation involving the upper extremity. Our aim was to study associations between those factors and unsuccessful revascularization to provide information for clinical decision-making regarding amputation injuries.
We studied all consecutive patients who had undergone an upper-extremity revascularization at Tampere University Hospital between 2009 and 2019. The primary outcome was the technical success or failure of the operation, which was defined as the survival or non-survival of the amputated tissue. Using logistic regression, we analyzed prognostic factors including age, sex, smoking status, diabetes mellitus, injury mechanism (cut, crush, or avulsion), extent of tissue loss before treatment (number of lost joints), and amputation type (total or subtotal).
A total of 282 patients (mean age, 47 years; 14% female; mostly White Caucasian) were included. The proportion of successful revascularizations (survival of all reconstructed tissue) was 76% (214 of 282). An avulsion injury mechanism (adjusted odds ratio [aOR], 5.9; 95% confidence interval [CI], 2.5 to 14.2), crush injury mechanism (aOR, 2.8; 95% CI, 1.1 to 7.0]), and total amputation type (aOR, 2.9; 95% CI, 1.5 to 5.8) were the prognostic factors that were associated with the highest risk of unsuccessful revascularizations. We found an S-shaped, nonlinear association between patient age and unsuccessful revascularizations and a U-shaped, nonlinear association between the amount of tissue loss before treatment and unsuccessful revascularizations. There was no evidence of an association between unsuccessful revascularizations and patient sex, smoking, or diabetes mellitus.
Injury details were the most significant prognostic factors of an unsuccessful upper-extremity revascularization, while age was the only patient characteristic that was associated with this outcome. In particular, total amputation type and avulsion and crush injury mechanisms yielded a higher risk of unsuccessful revascularization. We recommend considering this information when making decisions regarding the treatment of upper-extremity amputation injuries.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
用于创伤性上肢截肢的显微外科急诊血管重建手术需要大量资源。损伤细节和患者特征会影响上肢截肢是否进行血管重建或修正的决策。我们的目的是研究这些因素与血管重建失败之间的关联，为上肢截肢损伤的临床决策提供信息。
我们研究了2009年至2019年期间在坦佩雷大学医院接受上肢血管重建的所有连续患者。主要结局是手术的技术成功或失败，定义为截肢组织的存活或未存活。我们使用逻辑回归分析了预后因素，包括年龄、性别、吸烟状况、糖尿病、损伤机制（切割、挤压或撕脱）、治疗前组织丢失程度（丢失关节数量）和截肢类型（完全或不完全）。
共纳入282例患者（平均年龄47岁；14%为女性；大多为白种人）。血管重建成功（所有重建组织存活）的比例为76%（282例中的214例）。撕脱伤机制（调整优势比[aOR]，5.9；95%置信区间[CI]，2.5至14.2）、挤压伤机制（aOR，2.8；95%CI，1.1至7.0）和完全截肢类型（aOR，2.9；95%CI，1.5至5.8）是与血管重建失败风险最高相关的预后因素。我们发现患者年龄与血管重建失败之间呈S形非线性关联，治疗前组织丢失量与血管重建失败之间呈U形非线性关联。没有证据表明血管重建失败与患者性别、吸烟或糖尿病之间存在关联。
损伤细节是上肢血管重建失败最重要的预后因素，而年龄是与该结局相关的唯一患者特征。特别是，完全截肢类型以及撕脱伤和挤压伤机制导致血管重建失败的风险更高。我们建议在做出上肢截肢损伤治疗决策时考虑这些信息。
预后水平III。有关证据水平的完整描述，请参阅作者指南。
