外伤性上肢截肢患者再植与修复术后临床结局的前瞻性研究

Comparison of clinical outcomes of replantation and repair after upper extremity amputation

目的探讨外伤性上肢截肢患者再植与修复术后临床结局的差异。方法选择2005年1~12月我院收治的80例外伤性上肢截肢患者。根据手术方法分为再植组(n=32)和修复组(n=48)。患者入院时,详细记录其性别、年龄、体质量指数(body mass index,BMI)、断肢缺血时间、吸烟史、嗜酒史、受教育程度、家庭年收入、糖尿病史、高血压病史、高血脂病史、心脏病史、精神疾病史等临床资料以及是否优势手、是否自己损伤、损伤类型、损伤部位、修复组患者假肢分类等损伤数据。断肢后1年,比较两组在DASH、MHQ、SF-36评分方面的差异。结果两组患者在性别、年龄、BMI、缺血时间、有吸烟史、有嗜酒史、受教育程度、家庭年收入、有糖尿病史、有高血压病史、有高血脂病史、有心脏病史、有精神疾病史临床资料方面相比,差异无统计学意义(P>0.05)。两组患者在是否优势手、是否自己损伤、损伤类型、损伤部位方面相比,差异无统计学意义(P>0.05)。再植组在SF-36评分(精神健康、活力、社会功能、情感职能、生理职能),MHQ评分(总体手功能、日常生活能力、工作能力、满意度)显著高于修复组,差异有统计学意义(P<0.05);在DASH评分方面显著低于修复组,差异有统计学意义(P<0.05)。结论外伤性上肢截肢术后再植患者的临床结局优于修复患者。

Objective To investigate the differences of clinical outcomes of replantation and repair after upper extremity amputation. Methods From Jan 2005 to Dec 2015, 80 patients with traumatic upper limb amputation were selected. All patients were divided into the replantation group（ n = 32） and the repair group（ n = 48） according to the operation methods. On admission, gender, age, body mass index（ BMI）, limb ischemia time, smoking history, drinking history, education background, family income, history of diabetes, hypertension, hyperlipidemia, coronary heart disease, mental disease, dominant hand, injury type, injury location were inquired and recorded. One years after the amputation, DASH, MHQ, SF-36 differences were compared between the 2 groups. Results There were no significant differences in gender, age, BMI, ischemia time, smoking history, drinking history, education background, family income, history of diabetes, hypertension, hyperlipidemia, coronary heart disease, psychiatric problem, dominant hand, injury type, injury location（ P 0.05）. SF-36 score（ mental health, vitality, social function, emotional function, physical function score） and MHQ score（ hand function, the overall ability of daily life, work ability, job satisfaction） in the replantation group were significantly higher than that of the repair group（ P 0.05）, while the DASH score was significantly lower than that of the repair group（ P 0.05）. Conclusions Clinical outcomes of replantation are better than that of the repair after traumatic upper limb amputation.