Pirksta replantācijas iznākumu ietekmējošie faktori
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads: Gandrīz katru nedēļu tiek stacionēti pacienti ar pilnīgu traumatisku pirkstu amputāciju. Taču ne visos gadījumos ir iespējama replantācija, un, ja arī tā tiek veikta, tā ne vienmēr ir veiksmīga. Darba mērķis bija novērtēt veiksmīgu pirksta replantāciju biežumu, kā arī noskaidrot ar pacientu un ar ķirurģiju saistītos riska faktorus, kas ietekmē replantētā pirksta izdzīvošanu. Materiāli un metodes: Pētījumā tika iekļauti 119 pacienti, kas tika stacionēti Mikroķirurģijas Centrā laika posmā no 2012. līdz 2018. gadam ar viena vai vairāku rokas pirkstu pilnu traumatisku viena līmeņa amputāciju, un kam tika veikta šo pirkstu mikrovaskulāra replantācija. Dati tika iegūti no medicīnas vēsturēm. Statistiskā analīze tika veikta ar IBM SPSS 22.0, tika izmantota binārā loģistiskā regresija un Manna Vitnija U tests. Rezultāti: No 119 pacientiem 85,7% bija vīrieši, un 14,3% bija sievietes. Vidējais vecums bija 41 gads (amplitūda 9-78 gadi). Kopumā tika replantēts 151 pirksts, no kuriem izdzīvoja 75,5% replantēto pirkstu. Neveiksmīga rezultāta izredzes palielinājās 1,09 reizes ar katru dienā izsmēķēto cigareti (p=0,028), 13,56 reizes dragātas traumas gadījumā salīdzinot ar giljotīnas tipa traumas mehānismu (p=0,003), un 14,62 reizes, ja amputācija bija Tamai II zonā, nekā ja tā bija I zonā (p=0,047). Neveiksmīga rezultāta izredzes samazinājās 1,89 reizes, ja tika rekonstruēta viena vēna (p=0,026), un 1,87 reizes, ja tika rekonstruētas divas vēnas (p=0,034), salīdzinot ar gadījumu, kad vēnas netika rekonstruētas. Vecums, dzimums, rekonstruēto artēriju skaits, laiks no traumas gūšanas brīža līdz operācijas beigām, pēcoperācijas periodā lietotie medikamenti, kā arī kardiovaskulāro un citu sistēmisko slimību esamība nebija statistiski nozīmīgi faktori. Secinājumi: Veiksmīgu pirksta replantāciju biežums bija 75,5%. Smēķēšana, dragāts traumas mehānisms un amputācija Tamai II zonā palielināja neveiksmīga rezultāta izredzes, bet viena vai divas rekonstruētas vēnas to samazināja.
Objectives: Almost every week patients are hospitalized with total traumatic digit amputations, but not in all cases replantation is possible and, if performed, not in every patient it is successful. The aim of the study was to evaluate the success rate and to identify the patient and the surgery associated risk factors affecting the survival of a replanted digit. Material and methods: The study included 119 patients, who were hospitalized in Microsurgery Centre from 2012 to 2018 with total traumatic one level amputation of one or more digits and underwent microvascular replantation. The data was obtained from medical histories. For statistical analysis IBM SPSS 22.0 was used, Binary logistic regression and Mann-Whitney U test were performed. Results: From 119 patients 85.7% were male and 14.3% were female. The mean age was 41 (range 9-78 years). Overall, 151 digits were replanted, the survival rate was 75.5%. Odds of unsuccessful result increased 1.09 times with every smoked cigarette a day (p=0.028), 13.56 times in case of crush trauma compared to guillotine trauma mechanism (p=0.003) and 14.62 times in case of Tamai zone II amputation compared to zone I amputation (p=0.047). Odds of unsuccessful result decreased 1.89 times in case of one vein reconstructed (p=0.026) and 1.87 times in case of two veins reconstructed (p=0.034) compared to no veins reconstructed. Age, sex, the number of reconstructed arteries, the time from trauma until the end of operation, use of medications in postoperative period, presence of cardiovascular and other systemic comorbidities were not obtained as statistically significant. Conclusions: The survival rate of the replanted digits was 75.5%. Smoking, crush trauma mechanism and Tamai zone II amputation level increased the possibility of unsuccessful outcome, meanwhile, one or two reconstructed veins lowered it.
Objectives: Almost every week patients are hospitalized with total traumatic digit amputations, but not in all cases replantation is possible and, if performed, not in every patient it is successful. The aim of the study was to evaluate the success rate and to identify the patient and the surgery associated risk factors affecting the survival of a replanted digit. Material and methods: The study included 119 patients, who were hospitalized in Microsurgery Centre from 2012 to 2018 with total traumatic one level amputation of one or more digits and underwent microvascular replantation. The data was obtained from medical histories. For statistical analysis IBM SPSS 22.0 was used, Binary logistic regression and Mann-Whitney U test were performed. Results: From 119 patients 85.7% were male and 14.3% were female. The mean age was 41 (range 9-78 years). Overall, 151 digits were replanted, the survival rate was 75.5%. Odds of unsuccessful result increased 1.09 times with every smoked cigarette a day (p=0.028), 13.56 times in case of crush trauma compared to guillotine trauma mechanism (p=0.003) and 14.62 times in case of Tamai zone II amputation compared to zone I amputation (p=0.047). Odds of unsuccessful result decreased 1.89 times in case of one vein reconstructed (p=0.026) and 1.87 times in case of two veins reconstructed (p=0.034) compared to no veins reconstructed. Age, sex, the number of reconstructed arteries, the time from trauma until the end of operation, use of medications in postoperative period, presence of cardiovascular and other systemic comorbidities were not obtained as statistically significant. Conclusions: The survival rate of the replanted digits was 75.5%. Smoking, crush trauma mechanism and Tamai zone II amputation level increased the possibility of unsuccessful outcome, meanwhile, one or two reconstructed veins lowered it.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Traumatiska pirksta amputācija, pirksta replantācija, riska faktori., Traumatic digit amputation, digit replantation, risk factors.