Hui Taotao, Tang Yinrao, Qiang Li
The Wuxi No.9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214000, China.
Eur J Trauma Emerg Surg. 2025 Jan 24;51(1):43. doi: 10.1007/s00068-024-02717-2.
Complicated wrist amputation caused by severe trauma poses a real challenge for orthopedic and hand surgeons. This study aimed to evaluate a procedure of ulnoradial-metacarpal reconstruction as a rescue option in this challenging situation.
In total, 12 patients with complicated wrist amputation induced by serious injury were selected from 2015 to 2020 and followed up for 1∼6 years at a level 1 trauma center. All patients underwent initial treatment in the Emergency Department followed by transfer to the main operating theater for emergency ulnoradial-metacarpal reconstruction. Patient demographics, surgical techniques, clinical outcomes, and complications were also retrieved from medical records. Functional outcomes were assessed with Disabilities of Arm, Shoulder and Hand score (DASH) and Mayo Wrist Score (MWS). Descriptive statistics were used to calculate, including frequencies for categorial variables and mean values and ranges for continuous variables.
The mean age of patients was 49.3 years (ranging from 41 to 61 years), with ten males and two females. The mean time to union was 4.8 months; 11 patients had a complete union. There was one case of nonunion due to bone resorption resulting from inadequate blood supply and smoking. Compared with the contralateral limb, the total active motion of the hand was 25% (ranging from 17 to 38%), and grip strength was 7% (ranging from 0 to 18%). Neither tip nor key pinch was present. Mean 2-point discrimination was 10.6 mm (ranging from 8 to 12 mm). All mean outcome scores indicated moderate disability, including disabilities of Arm, Shoulder, and Hand (12; ranging from 4 to 27). Based on Mayo Wrist Score, all patients were loss of wrist function forever. The majority of patients were satisfied with the hand function after recovery.
Despite all patients experiencing significant impairments in their overall hand function, ulnoradial-metacarpal fusion presents a viable option for hand replantation in instances where the carpus has been irreparably damaged.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
严重创伤导致的复杂性腕部截肢给骨科和手外科医生带来了真正的挑战。本研究旨在评估尺桡骨 - 掌骨重建手术作为在这种具有挑战性情况下的一种挽救选择。
从2015年至2020年共选取了12例因严重损伤导致复杂性腕部截肢的患者，并在一级创伤中心进行了1至6年的随访。所有患者均在急诊科接受初始治疗，随后转至主手术室进行急诊尺桡骨 - 掌骨重建。还从病历中获取了患者的人口统计学资料、手术技术、临床结果和并发症。使用手臂、肩部和手部功能障碍评分（DASH）和梅奥腕关节评分（MWS）评估功能结果。采用描述性统计进行计算，包括分类变量的频率以及连续变量的均值和范围。
患者的平均年龄为49.3岁（范围为41至61岁），其中男性10例，女性2例。平均愈合时间为4.8个月；11例患者实现了完全愈合。有1例因血供不足和吸烟导致骨吸收而出现骨不连。与对侧肢体相比，手部的总主动活动度为25%（范围为17%至38%），握力为7%（范围为0至18%）。既没有指尖捏力也没有钥匙捏力。平均两点辨别觉为10.6毫米（范围为8至12毫米）。所有平均结果评分均表明存在中度残疾，包括手臂、肩部和手部功能障碍（12；范围为4至27）。根据梅奥腕关节评分，所有患者的腕关节功能永久性丧失。大多数患者对恢复后的手部功能感到满意。
尽管所有患者的手部整体功能都有明显受损，但在腕骨已遭受不可修复损伤的情况下，尺桡骨 - 掌骨融合术是手部再植的一种可行选择。
研究类型/证据水平：治疗性IV级。
