Analysis Of Factors Influencing Postoperative Hand Function In DEB With Hand Deformities

BackgroundDystrophic epidermolysis bullosa is a genetic disease of increased epidermis and mucous membrane fragility,and blisters are produced when subjected to minor trauma.The skin develops blisters that break and heal on their own.Repeated occurrence of this process will lead to contracture scarring of the patient’s skin,especially scar contracture deformity of the patient’s hands,resulting in a decline in the ability of daily living.Since the age of patients with dystrophic epidermolysis bullosa is generally young,the deformities of the patients’ hands not only seriously affect the basic daily life of the patients,but also limit the recreational and social activities of the patients,affecting the mental health of the patients.The reconstruction of the function and appearance of the patient’s hands by surgical manipulation is very important for the patient’s reintegration into society.However,due to the use of the hand in the patient’s daily life,new blisters will be formed,and the clinical progress of the patient’s condition is inevitable,and the postoperative scar contracture of the hand will soon relapse.This resulted in limited hand function and reduced quality of life after operation.The prevalence of dystrophy epidermolysis bullosa is low and the patient population is small.At present,there are relatively few studies on the hand scar contracture deformity of patients with this disease in China,and there is no study on the influencing factors of postoperative hand function.However,it is of great concern whether the patients get a certain expected quality of life after surgery.ObjectiveBy analyzing the general clinical information and follow-up information of the patients,the influencing factors of hand function after the release of scar contracture of both hands in the patients with dystrophic epidermolysis bullosa hand deformity were studied.It is hoped that by controlling these influencing factors in the future clinical work,the interval of recurrence of the patients’ cicatricial contracture of both hands can be prolonged,so as to obtain better prognosis and quality of life.MethodsRetrospective analysis was performed on the patients with hand deformities of dystrophy epidermolysis bullosa who were admitted to our hospital since 2014.All the patients underwent deformities of both hands with scar contracture and were followed up.The hand function of the patients 2 years after the operation was scored according to the evaluation criteria established by Hand Surgery Society of Chinese Medical Association in 2000.And the patients were divided into two groups according to the scoring results.Those assessed as excellent and good were assigned to the group with unrestricted hand function,while those assessed as poor and inferior were assigned to the group with restricted hand function.Comparing the basic conditions of the two groups of patients,the use of postoperative hand braces and some common factors for any differences.ResultsA total of 43 patients were included in the effective follow-up information,which was classified according to hand function score,including 22 in the limited hand function group and 21 in the unrestricted hand function group.There were no statistically significant differences in age,gender,nationality,native place,BMI,BARTHEL index,nutritional status,hemoglobin concentration,blood glucose and coagulation function between the two groups(P>0.05),and there were statistically significant differences in the use of hand support between the two groups(P<0.005).The odds ratio was 11.01 for patients with brace fixation versus those without brace fixation.ConclusionsThrough into the general data and postoperative follow-up data were analyzed,and concluded that the patient age,gender,race,BMI,BARTHEL index,the concentration of albumin,hemoglobin concentration,blood glucose,prothrombin time and activated partial thromboplastin time to the patients with dystrophic epidermolysis bullosa postoperative hand function has no effect;The application of hand brace after surgical treatment is an important factor that affects the postoperative hand function of patients with dystrophic epidermolysis bullosa hands contractures deformities,the application of hand brace will prolong the recurrence interval.Postoperative use of hand brace can delay the recurrence of postoperative scar contracture of both hands,so that patients can obtain a longer effective time of hand use.