目的:手指截肢可能涉及不同程度的损伤复杂性,手指再植的成功进一步取决于多种因素,包括患者特征,外科技术,和术后康复。这些变量可能以复杂的方式相互作用,并导致异质性,这使得指导个体患者的管理具有挑战性。因此,本系统综述旨在回顾孤立性单指再植的结局,并比较患者报告的修正截肢后结局,以指导决策.
方法:美国国家医学图书馆(PubMed/Medline),系统搜索EMBASE和CINAHL,以确定与本系统综述相关的出版物。提取了从数据库开始到2022年10月15日发布的相关文章。纳入标准包括英语临床试验和观察性研究,报告单指位再植后任何功能或患者报告的结果。
结果:从符合筛选条件的初始1050个标题和摘要中,纳入了6项研究,代表550个个个位数的重新种植.有162个重新种植的拇指(162/550),正如三项研究报告的那样,和388个重新种植的手指(388/550),正如所有六项研究报告的那样。总的来说,所有6项研究均得出结论,非拇指单指再植可提供令人满意的结果.五项研究表明,在某些情况下,屈肌II区附近的单指再植可以取得合理的结果。其中两项比较研究(Zhu等人。[1],Chungetal.[2])与翻修截肢组相比,非拇指再植组的MHQ评分有统计学意义的增加(分别为87.6对84.6)。
结论:在技术上可行时,建议再植,即使在选择食指II区截肢。单指再植不能恢复受伤前的手功能,但成功后确实可以获得可接受的手功能。需要进一步的研究来更好地告知患者的风险分层,并指导病人,和外科医生对术后恢复的期望。
方法:III.
Finger amputations can involve different levels of injury complexity, and the success of a finger replantation is further shaped by a variety of factors, including patient characteristics, surgical technique, and postoperative rehabilitation. These variables may interact in complex ways and contribute to heterogeneity that makes it challenging to guide management for individual patients. As such, this systematic
review seeks
review the outcomes of isolated single digit replantation and compare patient reported outcomes following revision amputation to guide decision making.
The United States National Library of Medicine (PubMed/Medline), EMBASE and CINAHL were systematically searched to identify publications relevant to this systematic
review. Related articles that were published from database inception to October 15, 2022 were extracted. The inclusion criteria consisted of English language clinical trials and observational studies reporting any functional or patient-reported outcome following single digit replantation.
From the initial 1050 titles and abstracts that were eligible for screening, six studies representing 550 single digit replantations were included. There were 162 replanted thumbs (162/550), as reported in three studies, and 388 replanted fingers (388/550), as reported in all six studies. Overall, all six studies concluded that non-thumb single digit replantation can provide satisfactory outcomes. Five studies suggested that single digit replantation proximal to flexor zone II can have reasonable outcomes in select cases. Two of the comparative studies (Zhu et al. [1], Chung et al. [2]) showed a statistically significant increase in MHQ score in the non-thumb replant group in comparison to the revision amputation group (87.6 versus 84.6 respectively).
When technically feasible, replantation is recommended, even in select index finger zone II amputations. Single digit replantation does not restore pre-injury hand function but does result in acceptable hand function when successful. Further study is needed to better inform risk-stratification of patients, and guide patient, and surgeon expectations for post-operative recovery.
III.