关于断指再植选择的问卷调查研究

A questionnaire regarding the choice of digit replantation

目的调查普通人群和专科医生对于手指离断治疗方案的选择及其相关影响因素。方法针对普通人群和专科医生设计选择断指再植治疗方案相关问题的调查问卷。在问卷中假想了一个优势侧示指近指间关节完全离断的场景,让受访者选择更倾向于哪一种治疗方式,断指再植还是残端修整术。问卷中还请受访者回答手指功能、外观、感觉以及手术失败的概率、恢复时间等因素对其选择的影响程度。之后请医生组预估断指再植和残端修整术后恢复的情况。将问卷分发至符合入选标准的受访者并且回收问卷,对筛选出符合要求的问卷进行统计学分析。结果在吉林省内,回收普通人群组有效问卷100张,专科医生组有效问卷52张。大多数普通人群组(82%)及专科医生组(92%)的受访者选择了断指再植术,两组差异无统计学意义。两组受访者均认为手指活动功能和外观重要,两组差异无统计学意义。而普通人群组认为手指的感觉、手术失败的概率、恢复时间等因素更为重要,并影响其决定的比例也均明显高于医生组。医生组预估断指再植的结果要优于残端修整术,而残端修整术后恢复时间要短于再植的患者。结论虽然普通人群和医生都倾向于再植,医生对于断指再植的选择更大程度上考虑的是术后功能,而患者的选择往往还要考虑手术失败概率、时间和经济成本等因素。针对断指再植和残端修整术后功能的大规模的随访工作将是未来研究的方向。

Objective To compare the treatment preferences of amputated finger between general population and doctors and to investigate relevant factors.Methods We conducted a serial of surveys for general population and doctors that involved related issues about finger replantation.An imaginary circumstance that the index finger of the dominate hand severed at the level of proximal interphalangeal joint was presented to investigate which treatment was preferred to the participants,finger replantation or revision amputation.The surveys also required the participants to rank the importance degree of the relevant factors,such as,finger function,appearance,sensation,chance of survival of replant,recovery time etc.Moreover,the doctor group was required to estimate the postoperative functional results after finger replantation and revision amputation.Results The total number of valid return were 100 for general population group and 52 for doctor group in Jilin province.Most participants in both general population group(82%)and doctor group(92%)preferred finger replantation,but there was no significant difference between them.Both groups ranked finger function and appearance as important factors,whereas,general population preferred finger sensation,chance of survival of replant and recovery time as important factors and the ratio of general population group that considered them as important factors influencing treatment preference was higher than doctor group.Doctor group estimated the recovery function of finger replantation and amputation as that the result of replantation was better than amputation,and the recovery time for patients that performed amputation was shorter than that for patients under replantation.Conclusion Both groups had a strong preference for replantation.The doctor group concerned more about finger function,however,the general population group also considered chance of survival of replant,recovery time,and cost as treatment option selected.It is necessary to apply evidence-based medicine to assess the outcomes of digital replantation and revision amputation in the future.