以Hand Injury Severity Scoring System 預測受傷後之手功能

Abstract

目的：手外傷所導致的手功能缺損及其造成之日常生活功能影響無論在台灣或世界其他地區都是一日益嚴重的問題，為了能預測未來手功能不良的傷者，我們進行此一研究，利用HISS (Hand Injury Severity Scoring) 系統試圖預測受傷之後的手功能，包括手力量以及操作靈活度，藉此預測出需要及早介入的傷者並導入復健治療，以減少未來殘障的可能性，幫助傷者重回日常生活功能。 方法：我們選取了台灣某醫學中心自2004年至2008年手外傷開刀住院後半年以上的傷者，首先以電話問卷方式取得其基本資料及詢問參與意願，在取得受試者同意書後，選擇15-60歲，單側手受傷，且語言表達溝通無礙的傷者參與研究。初始手受傷嚴重度以入院時的Hand Injury Severity Scoring system (HISS)為測量工具。手功能部份我們分別測量手握力以及Minnesota Manual Dexterity Test (MMDT)、Purdue Pegboard (PP)等兩種手操作靈活度測試來代表受傷後手功能。並以logistic regression model來測量較差手功能與HISS分數間的關係，以及HISS component與手功能間的關係。 結果：在校正基本資料（包括年齡、性別、教育程度以及慣用手是否受傷）之後，我們發現一開始HISS分數較低的傷者，在六個月後手握力歸類於較差那組的危險性較大。在手握力的palmar pinch以及palmar grasp測試中，HISS分數列在severe/major的有較高的危險性歸類於較差的那組。而在HISS component中，skeletal這個component與palmar pinch及palmar grasp測試結果相關，以上均達統計學上顯著差異(P<0.05)。而在手操作靈活度的部份，無論MMDT或PP與HISS嚴重度或component均無達到統計學上的顯著差異。 結論：本研究發現HISS嚴重度能夠預測受傷進入穩定期後的手握力，能給予臨床醫療人員及早對這類傷者引入復健治療的指引。但對手操作靈活度這部份的手功能而言，本研究並未發現有顯著關係存在。

Purpose Hand strength is one of key components in human hand function. To evaluate post-injury hand functions, we conduct this study to assess the predictability of HISS (Hand Injury Severity Scoring) system to hand functions after a period of recovery. Methods In this retrospective study, eighty hand injured subjects were recruited. Hand strength tests measured by dynamometers were performed by subjects in ways of palmar pinch, lateral pinch and palmar grasp. Hand dexterity tests assessed by MMDT and Purdue pegboard tests. The logistic regression models were used to evaluate the risk of poor hand strength/dexterity among the severities represented by HISS scores. Results A negative correlation exists between the differences of the strength of two hands, and the severity shown by HISS system in the poorer half of subjects. The risk to be in poorer half of palmar pinch subtest is significant in severe/major subgroup of HISS severity. The risk to be in poorer half of palmar grasp subtest is significant in severe/major subgroup of HISS severity. The risk to be in poorer half of palmar pinch and palmar grasp subtests is significant in skeletal component of HISS system. No statistical significance is shown between HISS scores and MMDT/Purdue pegboard tests. Conclusions HISS is a descriptive severity scoring system to hand injury and also a useful instrument to predict functional outcome. This study revealed the low HISS scores may predict poor post-injury hand strength after adequate recovery.