Comparison of patient-reported outcomes after traumatic upper extremity amputation: Replantation versus prosthetic rehabilitation

作者：Pet Mitchell A; Morrison Shane D; Mack Jacob S; Sears Erika D; Wright Thomas; Lussiez Alisha D; Means Kenneth R; Higgins James P; Ko Jason H; Cederna Paul S; Kung Theodore A^*

来源：Injury-International Journal of the Care of the Injured, 2016, 47(12): 2783-2788.

DOI：10.1016/j.injury.2016.10.004

• Amputation
• Replantation
• Prosthetic rehabilitation
• Upper extremity
• Patient-reported outcomes
• DASH
• MHQ

Background: After major upper extremity traumatic amputation, replantation is attempted based upon the assumption that outcomes for a replanted limb exceed those for revision amputation with prosthetic rehabilitation. While some reports have examined functional differences between these patients, it is increasingly apparent that patient perceptions are also critical determinants of success. Currently, little patient-reported outcomes data exists to support surgical decision-making in the setting of major upper extremity traumatic amputation. Therefore, the purpose of this study is to directly compare patient-reported outcomes after replantation versus prosthetic rehabilitation.
Methods: At three tertiary care centers, patients with a history of traumatic unilateral upper extremity amputation at or between the radiocarpal and elbow joints were identified. Patients who underwent either successful replantation or revision amputation with prosthetic rehabilitation were contacted. Patient-reported health status was evaluated with both DASH and MHQ instruments. Intergroup comparisons were performed for aggregate DASH score, aggregate MHQ score on the injured side, and each MHQ domain.
Results: Nine patients with successful replantation and 22 amputees who underwent prosthetic rehabilitation were enrolled. Aggregate MHQ score for the affected extremity was significantly higher for the Replantation group compared to the Prosthetic Rehabilitation group (47.2 vs. 35.1, p < 0.05). Among the MHQ domains, significant advantages to replantation were demonstrated with respect to overall 41.1 vs. 19.7, p = 0.03), ADLs (28.3 vs. 6.0, p = 0.03), and patient satisfaction (46.0 vs. 24.4, p = 0.03). Additionally, Replantation patients had a lower mean DASH score (24.6 vs. 39.8, p = 0.08).
Conclusions: Patients in this study who experienced major upper extremity traumatic amputation reported more favorable patient-reported outcomes after successful replantation compared to revision amputation with prosthetic rehabilitation.

• 出版日期2016-12