不同病因对手部损伤患者生存能力和功能预后的影响。31例临床分析

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-03-01 DOI:10.1016/j.jhsg.2024.06.014

Ioannis A. Ignatiadis MD , Vasiliki A. Tsiampa MD , Pavlos Altsitzioglou MD , Emmanouil G. Daskalakis MD , Dimitrios K. Arapoglou MD , Andreas F. Mavrogenis MD

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引用次数: 0

摘要

目的：手角指的是影响许多解剖部位的严重损伤。这些损伤使用不同的评分系统进行评估。除了这些评分外，我们还需要包括与患者有关的关键方面，如创伤来源、预后和手术。我们研究了事故病因学在评估创伤和预测结果中的重要性，以及它们在指导创伤治疗决策中的价值。方法2004 ~ 2009年收治上肢复合性损伤31例，年龄6 ~ 73岁。我们记录了10起爆炸伤害，10起工伤事故，6起机动车事故，5起枪伤。采用严重程度、解剖、地形和类型评估方法对生存能力和功能进行预后评估。此外，我们还研究了病因对损伤预后的影响。功能结果采用手动肌肉测试分级系统评估，肢体有用性结果采用手臂、肩和手残疾（DASH）评分测试（患者自我问卷）评估。结果17例主要血管病变需要紧急重建或截肢。我们的研究结果表明，部分或全部截肢或使用皮瓣关闭残肢的爆炸伤病例预后较差。对于工伤的病例，我们进行了血运重建术或皮瓣，其中挽救肢体的可能性被认为高于术后并发症的潜在风险。对于枪伤患者，尽管整体功能较低，但我们的主要方法是修复而不是截肢，因为实现生存能力的潜在可行性。结论创伤原因是否对创伤评价评分和预测创伤结局有重要影响，有助于应急决策，有待进一步研究。研究类型/证据水平预后。

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Viability and Functional Prognosis in Mangled Hand Casualties Depending on Their Etiological Factors. A Study of 31 Cases

Purpose

Mangled hands refer to disfiguring severe injuries that affect many anatomical components. These injuries are evaluated using various scoring systems. In addition to these ratings, we need to include critical aspects relating to the patient, such as the trauma origin, prognosis, and procedure. We examined the significance of accident etiology in assessing trauma and predicting outcomes, as well as their value in guiding decisions for trauma treatment.

Methods

Thirty-one patients, from 6 to 73 years, have been treated for upper limb compound injuries at our hospital between 2004 and 2009. We registered 10 blast injuries, 10 work accidents, six motor vehicle accidents, and five gunshot injuries. The severity, anatomy, topography, and type assessment method was used to evaluate the prognosis on viability and functionality. Additionally, we studied the influence of the etiological factor on injury prognosis. The functional results have been assessed by the manual muscle testing grading system, whereas the results of the limb usefulness have been evaluated by Disabilities of Arm, Shoulder and Hand (DASH) score test (patients’ self-questionnaire).

Results

Seventeen cases involved major vascular lesions that required emergency reconstruction or amputation. Our findings indicate that cases with blast injuries managed by partial or total amputations or using flaps to close stumps had poor prognoses. For cases with work-related injuries, we performed revascularization or flaps where the likelihood of saving the limbs was deemed higher than the potential risks of postoperative complications. In cases with gunshot injuries, despite the low overall functioning seen, our primary approach was to repair rather than amputating because of the potential feasibility of achieving viability.

Conclusions

Further investigation is needed to determine if the cause of trauma has an important impact on trauma evaluation scores and predicting trauma outcomes, furthermore, helping decision making in emergencies.