Journal of Hand Surgery-American Volume最新文献_第5页

Outcomes of Zone II Flexor Tendon Repair Under General Versus Wide Awake Local Anesthesia: A Randomized Controlled Trial 全身麻醉与局部麻醉下 II 区屈肌腱修复术的效果：随机对照试验。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsa.2024.06.008

Tarek Abdalla El-Gammal MD , Waleed Riad Saleh MD , Yasser Farouk Ragheb MD , Mohamed Morsy MD , Mariam Abdelazim Ibrahim PT, OCS , Mina Safwat Fekry MD

Purpose

Wide awake local anesthesia no tourniquet (WALANT) is gaining popularity with flexor tendon repair. We hypothesized that results of zone II flexor tendon repair performed under WALANT would be superior to those performed under general anesthesia (GA).

Methods

A randomized controlled trial was conducted to compare results of repair of zone II flexor tendon lacerations under WALANT versus GA. Following sample size estimation, 86 digits were included and randomized into two groups. All surgeries were performed by a single surgeon using a six-stranded core stitch and running epitenon suture. All patients followed the same early active rehabilitation protocol. The primary outcome was recovery calculated using the Strickland and Glogovac criteria. Secondary outcomes included rupture rate, complication rate, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. All outcomes were reported at the 6-month visit for all patients.

Results

Of the 86 digits, three were lost to follow-up. Analysis was performed on 43 digits in the WALANT group and 40 in the GA group. Demographic characteristics including age and sex were comparable in both groups. Rupture of the repair occurred in two digits in each of the WALANT and GA groups. An excellent or good outcome was achieved in 49% and 56% of the digits in the WALANT and GA groups, respectively. This difference was not statistically significant. DASH scores averaged 12.9 and 8.4 for the WALANT and GA groups, respectively.

Conclusions

WALANT may not be superior to GA in regards function, rates of rupture, and patient-reported outcomes in repair of zone II flexor tendon lacerations. Surgeons can be confident in choosing either technique if rigorous patient selection, sound surgical technique, and proper hand therapy are employed.

Type of study/level of evidence

Therapeutic I.

目的：宽醒局部麻醉无止血带（WALANT）在屈肌腱修复术中越来越受欢迎。我们假设，在 WALANT 下进行 II 区屈肌腱修复的效果将优于在全身麻醉（GA）下进行的修复：我们进行了一项随机对照试验，以比较在 WALANT 和 GA 下进行 II 区屈肌腱裂伤修复的效果。在对样本量进行估算后，86位患者被纳入其中，并随机分为两组。所有手术均由一名外科医生使用六股核心缝合线和流水表皮腱缝合线完成。所有患者均遵循相同的早期积极康复方案。主要结果是根据 Strickland 和 Glogovac 标准计算的恢复情况。次要结果包括断裂率、并发症发生率以及手臂、肩部和手部残疾（DASH）评分。所有结果均在所有患者接受 6 个月检查时进行报告：结果：在 86 位患者中，有 3 位患者失去了随访机会。对 WALANT 组中的 43 个数字和 GA 组中的 40 个数字进行了分析。两组患者的年龄和性别等人口统计学特征相当。在 WALANT 组和 GA 组中，每组都有两个手指发生了修复断裂。WALANT组和GA组分别有49%和56%的手指获得了极好或良好的结果。这一差异无统计学意义。WALANT组和GA组的DASH评分平均值分别为12.9分和8.4分：结论：在修复II区屈肌腱撕裂伤时，WALANT在功能、断裂率和患者报告结果方面可能并不优于GA。如果采用严格的患者选择、合理的手术技巧和适当的手部治疗，外科医生可以放心选择这两种技术：治疗 I。

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引用次数: 0

Evaluation of Injured Structures and Circulation of Fingers From Photos Taken in the Emergency Department After Hand Injury 通过手部受伤后在急诊室拍摄的照片评估手指的受伤结构和血液循环。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsa.2024.07.009

Osman Orman MD , Baki Avşar Uzun MD , Ali Aydoğdu MD , Ethem Ayhan Ünkar MD , Mehmet Baydar MD , Gokhan Pehlivanoğlu MD

Purpose

This study aimed to assess the diagnostic accuracy of smartphone photographs, taken at the emergency department (ED) and shared with hand surgeons, in identifying critical circulatory issues and neurovascular bundle injury, as well as tendon and bone injuries.

Methods

The photographs of hand injuries of 50 patients who were referred to our ED between January 2020 and January 2022 were used to design a questionnaire. This questionnaire, including closed-ended questions about the injured structures, was shared with a group of hand surgeons via a WhatsApp group in Turkey. The experience levels of the surgeons were categorized as 0–5 years, 5–10 years, and above 10 years. Diagnostic accuracy was assessed by comparing the results with surgery notes as the reference standard.

Results

A total of 94 hand surgeons participated in the study. The accuracy of predicting critical circulatory issues in the hand/fingers from the smartphone photographs was 81.9%, with a sensitivity of 48.0% and a specificity of 91.4%. For neurovascular bundle injuries, the accuracy was 63.0%, with a sensitivity of 63.9% and a specificity of 61.5%. The accuracy of predicting tendon injuries was 64.9%, with a sensitivity of 81.1% and a specificity of 42.5%. The accuracy of predicting fracture was 74.7%, with a sensitivity of 70.9% and a specificity of 79.9%.

Conclusions

Identifying critical circulatory issues solely based on the shared photograph is inadequate. Similarly, evaluation based only on the photograph was insufficient for the detection of neurovascular bundle injuries, tendon ruptures, and fractures.

Clinical relevance

Digital images acquired in an ED setting and subsequent review of these images by hand surgeons may not be an adequately reliable strategy for determining the necessity of patient transfer.

目的：本研究旨在评估在急诊科（ED）拍摄并与手外科医生共享的智能手机照片在识别严重循环问题和神经血管束损伤以及肌腱和骨骼损伤方面的诊断准确性：利用 2020 年 1 月至 2022 年 1 月期间转诊到本院急诊科的 50 名患者的手部损伤照片设计了一份调查问卷。该问卷包括有关受伤结构的封闭式问题，通过土耳其的 WhatsApp 群组与手外科医生分享。外科医生的经验水平分为 0-5 年、5-10 年和 10 年以上。诊断准确性通过将结果与作为参考标准的手术记录进行比较来评估：共有 94 名手外科医生参与了这项研究。根据智能手机照片预测手部/手指严重循环问题的准确率为 81.9%，敏感性为 48.0%，特异性为 91.4%。神经血管束损伤的准确率为 63.0%，灵敏度为 63.9%，特异度为 61.5%。预测肌腱损伤的准确率为 64.9%，敏感性为 81.1%，特异性为 42.5%。预测骨折的准确率为 74.7%，敏感性为 70.9%，特异性为 79.9%：结论：仅根据共享照片来识别关键的循环系统问题是不够的。同样，仅根据照片进行评估也不足以发现神经血管束损伤、肌腱断裂和骨折：临床相关性：在急诊室环境中获取的数字图像以及手外科医生随后对这些图像的审查可能并不是确定是否有必要转运病人的可靠策略。

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引用次数: 0

Increasing Prevalence of Xylazine and Worsening Upper-Extremity Wounds in Injection Drug Use: A Local Phenomenon With National Implications 注射吸毒者使用赛拉嗪和上肢伤口恶化的现象日益普遍：具有全国影响的地方现象。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsa.2024.07.017

Kirin Naidu BSE, MPhil , Carrie Z. Morales MD , Elizabeth B. Card MD , Ines C. Lin MD, MSEd

The rising presence of xylazine in Philadelphia’s fentanyl supply has led to various upper-extremity complications in individuals who inject drugs. Sociogeographic trends predict that our current local phenomenon will spread nationally. We aim to discuss the drug’s impact on clinical presentation and patient care via a cohort of five patients with upper-extremity wounds related to drug use. Interventions included local wound care, revascularization, compartment release, free flap reconstruction, and amputation. Successful treatment of these patients, who are often in challenging psychosocial environments, requires an individualized and interdisciplinary approach including surgical services, infectious disease, wound care, addiction medicine, psychiatry, social services, and prosthetic services.

费城的芬太尼供应中出现了越来越多的异丙嗪，导致注射毒品者出现各种上肢并发症。社会地理趋势预示着我们当前的地方现象将在全国范围内蔓延。我们的目的是通过五名因使用毒品而造成上肢伤口的患者，讨论毒品对临床表现和患者护理的影响。干预措施包括局部伤口护理、血管重建、腔室松解、游离皮瓣重建和截肢。这些患者往往处于极具挑战性的社会心理环境中，要想成功治疗他们，需要采取个性化的跨学科方法，包括外科服务、传染病、伤口护理、成瘾医学、精神病学、社会服务和假肢服务。

引用次数: 0

Do Nails and Nubbins Matter? A Comparison of Symbrachydactyly and Transverse Deficiency Phenotypes 指甲和脐带重要吗？共生畸形和横向缺失表型的比较。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsa.2023.01.021

Purpose

Transverse deficiency (TD) and symbrachydactyly may be difficult to distinguish due to shared phenotypes and a lack of pathognomonic features. The 2020 Oberg-Manske-Tonkin classification update modified these anomalies to include “with ectodermal elements” for symbrachydactyly and “without ectodermal elements” for TD as a defining differentiating characteristic. The purpose of this investigation was to characterize ectodermal elements and the level of deficiency and to examine whether ectodermal elements versus the level of deficiency was a greater determining factor for Congenital Upper Limb Differences (CoULD) surgeons making the diagnosis.

Methods

This was a retrospective review of 254 extremities from the CoULD registry with a diagnosis of symbrachydactyly or TD by pediatric hand surgeons. Ectodermal elements and the level of deficiency were characterized. A review of the registry radiographs and photographs was used to classify the diagnosis and compare it with the diagnosis given by the pediatric hand surgeons. The presence/absence of nubbins versus the level of deficiency as the determining factor to differentiate the pediatric hand surgeons’ diagnosis of symbrachydactyly (with nubbins) versus TD (without nubbins) was analyzed.

Results

Based on radiographs and photographs of the 254 extremities, 66% had nubbins on the distal end of the limb; of the limbs with nubbins, nails were present on 51%. The level of deficiency was amelia/humeral (n = 9), <1/3 transverse forearm (n = 23), 1/3 to 2/3 transverse forearm (n = 27), 2/3 to full forearm TD (n = 38), and metacarpal/phalangeal (n = 103). The presence of nubbins was associated with a four times higher likelihood of a pediatric hand surgeon’s diagnosis of symbrachydactyly. However, a distal deficiency is associated with a 20-times higher likelihood of a diagnosis of symbrachydactyly than a proximal deficiency.

Conclusions

Although both the level of deficiency and ectodermal elements are important, the level of deficiency was a greater determining factor for a diagnosis of symbrachydactyly versus TD. Our results suggest that the level of deficiency and nubbins should both be described to help provide greater clarity in the diagnosis of symbrachydactyly versus TD.

Type of study/level of evidence

Diagnostic IV.

目的：横突缺失症（TD）和共生畸形（Symbrachydactyly）由于具有共同的表型和缺乏病理特征，可能难以区分。2020 年，Oberg-Manske-Tonkin 对这些畸形进行了分类更新，将 "有外胚层元素 "和 "无外胚层元素 "分别作为共生畸形和横断缺失症的定义区分特征。这项调查的目的是确定外胚层元素和缺失程度的特征，并研究外胚层元素和缺失程度是否是先天性上肢畸形（CoULD）外科医生做出诊断的更重要的决定性因素：这是一项回顾性研究，小儿手外科医生从先天性上肢缺损（CoULD）登记册中诊断出254例共生畸形或TD的肢体。对外胚层元素和缺损程度进行了特征描述。通过审查登记处的X光片和照片，对诊断进行分类，并与小儿手外科医生的诊断进行比较。结果分析了有/无凸点与缺损程度作为区分小儿手外科医生诊断的共生畸形（有凸点）与TD（无凸点）的决定性因素：根据254个肢体的X光片和照片，66%的肢体远端有趾甲；在有趾甲的肢体中，51%有趾甲。缺损程度为羊角风/肱骨（n = 9）：尽管缺失程度和外胚层元素都很重要，但缺失程度是诊断共生畸形与TD的更重要决定因素。我们的研究结果表明，应同时描述缺失程度和外胚层元素，以帮助更清晰地诊断共生畸形与TD：诊断 IV.

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引用次数: 0

Factors Influencing Patient Experience After Cubital Tunnel Syndrome Surgery 影响肘隧道综合征手术后患者体验的因素。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsa.2023.03.012

Purpose

The purpose of this study was to use qualitative methodology to better understand patient experiences after cubital tunnel surgery, with the goal of identifying areas of improvement in delivery of care.

Methods

Patients who underwent surgery (in situ decompression or anterior transposition) for cubital tunnel syndrome within the last 12 months, which was performed by one of three fellowship-trained hand surgeons, were identified. Participants were invited to an interview regarding “their experiences with ulnar nerve surgery.” An interview guide with semistructured, open-ended questions regarding the decision for surgery, treatment goals, and the recovery process was used. Interim data analyses were conducted to assess emerging themes, and interviews were continued until thematic saturation was achieved.

Results

Seventeen participants completed interviews; the mean age of study participants was 57 years, and 71% were women. The mean time between surgery and the interview was 6 months. Participants identified the following two key areas that could improve their surgical experience: (1) the need for detailed preoperative education about the surgery and recovery process, (2) and the importance of discussing treatment goals and expectations. Participants suggested providing both written and online resources to patients, including specific details about incision size and recovery process in education materials, and setting expectations for symptom resolution.

Conclusions

Although the overall patient experience after cubital tunnel surgery was positive, participants noted that there is a need for providing improved educational resources and counseling before surgery.

Clinical relevance

Addressing education and counseling needs before cubital tunnel surgery will help surgeons to improve delivery of care.

目的：本研究旨在使用定性方法更好地了解患者在接受立方腕管手术后的经历，从而确定在提供护理服务方面需要改进的地方：确定了在过去 12 个月内接受过手术（原位减压或前路转位）治疗肘隧道综合征的患者，手术由三位接受过研究培训的手外科医生之一实施。他们受邀参加了关于 "尺神经手术经验 "的访谈。访谈采用半结构化、开放式的问题指南，内容涉及手术决定、治疗目标和恢复过程。我们进行了中期数据分析，以评估新出现的主题，并继续进行访谈，直到达到主题饱和为止：17名参与者完成了访谈；研究参与者的平均年龄为57岁，71%为女性。手术与访谈之间的平均间隔时间为 6 个月。参与者认为以下两个关键领域可以改善他们的手术体验：(1) 需要对手术和恢复过程进行详细的术前教育，(2) 讨论治疗目标和期望的重要性。与会者建议向患者提供书面和在线资源，在教育材料中包括有关切口大小和恢复过程的具体细节，并对症状的解决设定期望值：尽管患者在接受肘隧道手术后的总体体验是积极的，但与会者指出，有必要在手术前提供更好的教育资源和咨询服务：临床意义：解决肘隧道手术前的教育和咨询需求将有助于外科医生改善护理服务。

{"title":"Factors Influencing Patient Experience After Cubital Tunnel Syndrome Surgery","authors":"","doi":"10.1016/j.jhsa.2023.03.012","DOIUrl":"10.1016/j.jhsa.2023.03.012","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to use qualitative methodology to better understand patient experiences after cubital tunnel surgery, with the goal of identifying areas of improvement in delivery of care.</div></div><div><h3>Methods</h3><div>Patients who underwent surgery (<em>in situ</em><span> decompression or anterior transposition) for cubital tunnel syndrome<span> within the last 12 months, which was performed by one of three fellowship-trained hand surgeons, were identified. Participants were invited to an interview regarding “their experiences with ulnar nerve surgery.” An interview guide with semistructured, open-ended questions regarding the decision for surgery, treatment goals, and the recovery process was used. Interim data analyses were conducted to assess emerging themes, and interviews were continued until thematic saturation was achieved.</span></span></div></div><div><h3>Results</h3><div><span>Seventeen participants completed interviews; the mean age of study participants was 57 years, and 71% were women. The mean time between surgery and the interview was 6 months. Participants identified the following two key areas that could improve their surgical experience: (1) the need for detailed preoperative education about the surgery and recovery process, (2) and the importance of discussing treatment goals and expectations. Participants suggested providing both written and online resources to patients, including specific details about </span>incision size and recovery process in education materials, and setting expectations for symptom resolution.</div></div><div><h3>Conclusions</h3><div>Although the overall patient experience after cubital tunnel surgery was positive, participants noted that there is a need for providing improved educational resources and counseling before surgery.</div></div><div><h3>Clinical relevance</h3><div>Addressing education and counseling needs before cubital tunnel surgery will help surgeons to improve delivery of care.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"49 11","pages":"Pages 1146.e1-1146.e8"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9417371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Over-the-Top Foveal Triangular Fibrocartilage Complex Repair 顶部上方三角纤维软骨复合体修复术

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsa.2024.07.015

Sanjeev Kakar MD , Lauren E. Dittman MD , Andreas Rozenits MD , Robert Kalapos MD

There are many techniques that address triangular fibrocartilage complex foveal injuries, which are typically performed with an outside to inside technique. In this article, we describe an inside to outside triangular fibrocartilage complex repair technique that may result in more accurate suture passage and mitigate the risk of fracture from ulna tunnels.

解决三角纤维软骨复合窝损伤的技术有很多，通常采用从外向内的技术。在本文中，我们将介绍一种从内向外的三角纤维软骨复合体修复技术，该技术可实现更精确的缝合通道，并降低尺骨隧道骨折的风险。

引用次数: 0

Journal CME Questions 期刊继续医学教育问题

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsa.2024.09.011

引用次数: 0

Test–Retest Reliability and Precision of the Rotterdam Intrinsic Hand Myometer Rotterdam手部固有肌张力计的可靠性和精密度测试。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsa.2023.01.023

Purpose

The purpose of this study was to determine the test–retest reliability and precision of Rotterdam Intrinsic Hand Myometer (RIHM) in healthy adults.

Methods

Twenty-nine participants originally recruited via convenience sampling at a Midwestern state fair returned approximately 8 days later for retest. An average of three trials for each of the five intrinsic hand strength measurements were collected using the same technique that was used during initial testing. Test–retest reliability was assessed using the intraclass correlation coefficient or ICC_(2,3) and precision was evaluated using the standard error of measurement (SEM), and the minimal detectable change (MDC₉₀)/MDC%.

Results

Across all measures of intrinsic strength, the RIHM and its standardized procedures had excellent test–retest reliability. Index finger metacarpophalangeal flexion demonstrated the lowest reliability, and right small finger abduction, left thumb carpometacarpal abduction, and index finger metacarpophalangeal abduction tests had the highest reliability. Precision, as evidenced by SEM and MDC values, was excellent for tests of left index and bilateral small finger abduction strength and acceptable for all other measurements.

Conclusions

Test–retest reliability and precision of RIHM across all measurements was excellent.

Clinical relevance

These findings indicate that RIHM is a reliable and precise tool in measuring intrinsic strength of hands of healthy adults, although further research is needed in clinical populations.

目的：本研究的目的是确定鹿特丹内在手肌测量仪（RIHM）在健康成年人中的重新测试可靠性和准确性。方法：最初在中西部州博览会上通过方便抽样招募的29名参与者在大约8天后返回进行重新测试。使用与初始测试中使用的技术相同的技术，对五种内在手部强度测量中的每一种平均进行三次试验。使用组内相关系数或ICC（2，3）评估测试-再测试的可靠性，使用标准测量误差（SEM）和最小可检测变化（MDC90）/MDC%评估精度。结果：在所有内在强度测量中，RIHM及其标准化程序具有良好的再测试可靠性。食指掌指屈曲测试的可靠性最低，右手小指外展、左手拇指腕掌外展和食指掌指外展测试的可靠性最高。如SEM和MDC值所证明的，精度对于测试左食指和双侧小指外展强度是极好的，并且对于所有其他测量都是可接受的。结论：RIHM在所有测量中的测试-再测试可靠性和准确性都很好。临床相关性：这些发现表明，RIHM是测量健康成年人双手内在力量的可靠和精确的工具，尽管还需要在临床人群中进行进一步的研究。

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引用次数: 0

Comparative Analysis of Radial Corrective Osteotomy and Sauvé–Kapandji Procedure for Malunited Distal Radius Fractures in Older Adults 桡骨矫正截骨术与 Sauvé-Kapandji 手术治疗老年人桡骨远端钝性骨折的比较分析。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsa.2024.06.007

Lei Wang MD , Ziyang Huang MD , Wei Xie MD , Deqing Luo MD , Hui Liu MD, PhD , Kejian Lian MD , Dasheng Lin MD, PhD

Purpose

Malunited distal radius fractures frequently occur in the older population, posing a dilemma in selecting ideal management for symptomatic patients. Radial corrective osteotomy (RCO) and the Sauvé–Kapandji procedure (SK) have been used to treat this challenging condition. However, it remains unknown which approach is better for the older population. The objective of this study was to compare the outcomes of RCO with those of SK for the treatment of symptomatic distal radius malunion in older adults.

Methods

Thirty-three patients aged ≥60 years, with malunited distal radius fractures, were randomized to be treated with either RCO or SK and followed for a minimum of 2 years. The primary evaluation parameter was grip strength, and secondary outcome parameters were surgical time, range of motion of the wrist, exercise-related wrist pain assessment using visual analog scale scores, radiographic results, patient-reported outcomes evaluated using the Disability of the Arm, Shoulder, and Hand (DASH), and Patient-Related Wrist Evaluation (PRWE) scores.

Results

The average follow-up duration was 36.7 ± 10.2 months. The grip strength was significantly higher in the RCO group. The surgical time was shorter in the SK group than in the RCO group. The postoperative wrist range of motion and visual analog scale scores for exercise-related pain alleviation were similar in both groups. The ulnar variance decreased in both groups and was similar when compared with the postoperative images. The DASH and PRWE scores were similar between the RCO and SK groups.

Conclusions

Radial corrective osteotomy and SK surgeries have similar clinical and functional outcomes in patients aged ≥60 years. Grip strength is higher in the RCO group than in the SK group. However, the operating time to accomplish SK is shorter than RCO.

Type of study/level of evidence

Therapeutic II.

目的：桡骨远端畸形骨折经常发生在老年人群中，这给有症状的患者选择理想的治疗方法带来了难题。桡骨矫正截骨术（RCO）和Sauvé-Kapandji手术（SK）已被用于治疗这种具有挑战性的病症。然而，哪种方法更适合老年人群仍是个未知数。本研究旨在比较RCO和SK治疗老年人症状性桡骨远端骨不连的效果：33名年龄≥60岁、桡骨远端骨折错合的患者被随机分配接受RCO或SK治疗，并接受至少2年的随访。主要评估参数为握力，次要结果参数为手术时间、腕关节活动范围、使用视觉模拟量表评分进行的运动相关腕痛评估、放射学结果、使用手臂、肩部和手部残疾（DASH）评估的患者报告结果以及患者相关腕关节评估（PRWE）评分：平均随访时间为（36.7 ± 10.2）个月。RCO 组的握力明显更高。SK组的手术时间短于RCO组。两组的术后腕关节活动范围和运动相关疼痛缓解视觉模拟量表评分相似。两组的尺侧方差均有所减少，与术后图像相比也相似。RCO组和SK组的DASH和PRWE评分相似：结论：对于年龄≥60岁的患者，桡骨矫正截骨术和SK手术具有相似的临床和功能效果。RCO组的握力高于SK组。不过，完成 SK 的手术时间比 RCO 短：研究类型/证据级别：治疗 II。

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引用次数: 0

Swelling, Stiffness, and Dysfunction Following Proximal Interphalangeal Joint Sprains 近端指间关节扭伤后的肿胀、僵硬和功能障碍。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsa.2023.01.025

Purpose

Proximal interphalangeal (PIP) joint sprains are common injuries that often result in prolonged swelling, stiffness, and dysfunction; however, the duration of these sequelae is unknown. The purpose of this study was to determine the duration of time that patients experience finger swelling, stiffness, and dysfunction following a PIP joint sprain.

Methods

This was a prospective, longitudinal, survey-based study. To identify patients with PIP joint sprains, the electronic medical record was queried monthly using International Classification of Disease, Tenth Revision, codes for PIP joint sprain. A five-question survey was emailed monthly for 1 year or until their response indicated resolution of swelling, whichever occurred sooner. Two cohorts were established: patients with (resolution cohort) and patients without (no-resolution cohort) self-reported resolution of swelling of the involved finger within 1 year of a PIP joint sprain injury. The measured outcomes included self-reported resolution of swelling, self-reported limitations to range of motion, limitations to activities of daily living, Visual Analog Scale (VAS) pain score, and return to normalcy.

Results

Of 93 patients, 59 (63%) had complete resolution of swelling within 1 year of a PIP joint sprain. Of the patients in the resolution cohort, 42% reported return to subjective normalcy, with 47% having self-reported limitations in range of motion and 41% having limitations in activities of daily living. At the time of resolution of swelling, the average VAS pain score was 0.8 out of 10. In contrast, only 15% of patients in the no-resolution cohort reported return to subjective normalcy, with 82% having self-reported limitations in range of motion and 65% having limitations in activities of daily living. For this cohort, the average VAS pain score at 1 year was 2.6 out of 10.

Conclusions

It is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains.

Type of study/level of evidence

Prognostic IV.

目的：近端指间关节（PIP）扭伤是一种常见的损伤，通常会导致长时间的肿胀、僵硬和功能障碍；然而，这些后遗症的持续时间尚不清楚。本研究的目的是确定 PIP 关节扭伤后患者手指肿胀、僵硬和功能障碍的持续时间：这是一项前瞻性纵向调查研究。为了识别 PIP 关节扭伤患者，我们每月使用《国际疾病分类》第十版中 PIP 关节扭伤的代码查询电子病历。每月通过电子邮件发送一份包含五个问题的调查问卷，为期一年，或直到他们的回复显示肿胀缓解为止，以时间在前者为准。我们建立了两个队列：自述在 PIP 关节扭伤后 1 年内受累手指肿胀缓解的患者（缓解队列）和未缓解的患者（未缓解队列）。测量结果包括自我报告的肿胀消退情况、自我报告的活动范围限制、日常生活活动限制、视觉模拟量表（VAS）疼痛评分以及恢复正常情况：在93名患者中，有59人（63%）在PIP关节扭伤后1年内完全消除了肿胀。在肿胀消退的患者中，42%的人报告主观上已恢复正常，47%的人自述活动范围受限，41%的人自述日常生活活动受限。肿胀缓解时，VAS 疼痛评分的平均值为 0.8（满分 10 分）。相比之下，在肿胀未消退组中，只有 15% 的患者报告主观感觉恢复正常，其中 82% 的患者自述活动范围受限，65% 的患者自述日常生活活动受限。该组患者 1 年后的平均 VAS 疼痛评分为 2.6（满分 10 分）：结论：PIP 关节扭伤后，患者普遍会经历长时间的肿胀、僵硬和功能障碍：预后IV级

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引用次数: 0