早期与延迟手术治疗开放性手部损伤患者临床疗效的研究

Clinical efficacy of early versus delayed surgery in patients with open hand injuries

目的对比早期手术治疗与延迟手术治疗对开放性手部损伤患者临床疗效的影响。方法回顾性分析2019年1月至2022年1月期间在首都医科大学附属北京友谊医院就诊的483例开放性手部损伤患者的临床资料。根据受伤至手术时间将患者分为早期手术组(受伤距手术时间<6 h,n=251)和延迟手术组(受伤距手术时间6~24 h,n=232)。比较两组患者的损伤程度、伤口感染发生率、手术翻修发生率,以及通过腕关节自评量表(PRWE)评估的手部功能恢复情况。按照损伤程度不同,比较简单损伤与复杂损伤患者手部伤口感染、手术翻修发生率和PRWE腕关节自评量表评分。结果早期手术组与延迟手术组损伤严重程度比较,差异无统计学意义(P>0.05)。两组共发生手部伤口感染65例(13.5%)。简单损伤患者中,早期手术组与延迟手术组的感染发生率分别为17.1%和12.8%;复杂损伤患者中,两组感染率分别为14.3%和10.3%,早期手术组与延迟手术组的感染发生率比较,差异均无统计学意义(P>0.05)。两组共发生手术翻修95例(19.7%)。简单损伤患者中,早期和延迟手术组翻修发生率分别为8.1%和12.8%,复杂损伤患者中,两组翻修发生率分别为22.9%和29.5%;早期手术组与延迟手术组的手术翻修发生率比较,差异均无统计学意义(P>0.05)。简单损伤患者中,早期手术组与延迟手术组的术后PRWE量表评分分别为(7.78±1.87)、(7.93±2.04)分;简单损伤患者中,两组的术后PRWE量表评分分别为(8.07±2.03)、(8.73±3.61)分,早期手术组与延迟手术组的术后PRWE量表评分比较,差异均无统计学意义(P>0.05)。复杂损伤患者的翻修发生率为26.2%,显著高于简单损伤患者(10.2%),PRWE评分为(8.41±1.93)分,显著高于简单损伤患者[(7.85±1.95)分],差异均有统计学意义(P<0.05)。结论手部开放性损伤的延迟手术治疗(6-24 h)不会增加手术的感染或翻修发生率,对手部功能的恢复亦无显著影响,但患者的损伤结构的复杂性以及手术时间对功能结果有显著影响。

Objective To compare the clinical efficacy of early surgical treatment versus delayed surgical treatment in patients with open hand injuries.Methods A retrospective analysis of 483 patients with open hand injuries admitted to Beijing Friendship Hospital,Capital Medical University from January 2019 to January 2022 was performed.Patients were divided into an early surgery group(time from injury to surgery<6 h,n=251)and a delayed surgery group(time from injury to surgery 6-24 h,n=232)based on the timing of surgery.The degree of injury,incidence of wound infection,incidence of surgical revision were compared between two groups,and functional recovery assessed by the Patient-Rated Wrist Evaluation(PRWE)were compared between the two groups.According to the degree of injury,the incidence of hand wound infection,surgical revision,and PRWE wrist joint self-assessment scale scores were compared between patients with simple and complex injuries.Results There was no statistically significant difference in the severity of injury between the early surgery group and the delayed surgery group(P>0.05).There were 65 cases(13.5%)of hand wound infections occurred in both groups.In patients with simple injuries,the infection rates in the early surgery group and the delayed surgery group were 17.1%and 12.8%,respectively;in patients with complex injuries,the infection rates of the two groups were 14.3%and 10.3%,respectively.There was no statistically significant difference in the infection rates between the early surgery group and the delayed surgery group(P>0.05).There were 95 cases(19.7%)underwent surgical revision in both groups.In patients with simple injuries,the rates of revision in the early surgery group and delayed surgery groups were 8.1%and 12.8%,respectively.In patients with complex injuries,the rates of revision in the two groups were 22.9%and 29.5%,respectively.There was no statistically significant difference in the incidence of surgical revision between the early surgery group and the delayed surgery group(P>0.05).In patients with simple injuries,the postoperative PRWE scores of the early surgery group and the delayed surgery group were(7.78±1.87)and(7.93±2.04)points,respectively;in patients with simple injuries,the postoperative PRWE scores of the two groups were(8.07±2.03)and(8.73±3.61)points,respectively.There was no statistically significant difference in the postoperative PRWE scores between the early surgery group and the delayed surgery group(P>0.05).The incidence of revision in patients with complex injuries was 26.2%,which was significantly higher than that in patients with simple injuries(10.2%),the PRWE score was(8.41±1.93)points,which was significantly higher than that in patients with simple injuries[(7.85±1.95)points],and the differences were statistically significant(P<0.05).Conclusion Postponing surgery to 6-24 hours after open hand injuries does not heighten the likelihood of surgical infection or remake surgery,and shows no notable influence on the restoration of hand function.However,the complexity of the patient's injury structure and the duration of surgery have a significant impact on functional outcomes.