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Abstract Objective To explore the risk factors for poor functional recovery of replanted fingers，and establish a predictive model for poor functional recovery of severed fingers.Methods A retrospective analysis was performed on the data of 309 patients (376 severed fingers) who underwent finger replantation surgery at Tangshan People’s Hospital between May 2017 and May 2022.Among them，231 males accounted for 274 severed fingers，while 78 females accounted for 102 severed fingers，with ages ranging from 19 to 67 years，and an average age of (41.57±8.59)years.One year post-surgery，the recovery of severed finger function was assessed，and patients were categorized into a poor recovery group and a control group.Univariate screening was conducted to collect data on patients’ general demographic characteristics，disease information，surgical details，and preoperative blood routine indicators.Multivariate analysis was then utilized to identify risk factors for poor finger function recovery，and the effect size of each indicator was visualized in a forest plot.Subsequently，a predictive model using column charts was constructed，and its efficacy was evaluated through the receiver operating characteristic (ROC) curve area under the curve (AUC)，calibration curve，and decision curve analysis (DCA).Results Among the 309 patients (376 severed fingers)，68 patients (81 severed fingers) exhibited poor postoperative functional recovery，representing 21.54% of the total.Statistically significant differences were observed between the two groups in smoking history，nature of injury，degree of amputation，amputation plane，exposure time of severed fingers，preservation method of severed fingers，and compliance with medical advice on rehabilitation exercise (P＜0.05).Logistic regression analysis revealed that the primary risk factors for poor functional recovery of severed fingers after surgery were smoking history，avulsion injury，amputation plane non-distal to the phalanx，exposure time of severed fingers ≥8 hours，and failure to adhere to medical advice on rehabilitation exercise.Internal validation indicated an AUC of 0.819 (95% CI：0.762~0.875)，suggesting a high consistency between the model’s predicted probability of poor functional recovery and the actual probability.The goodness-of-fit HL test yielded χ2=7.389 and P＝0.286，further supporting the model’s fit.DCA analysis demonstrated that the model exhibited good practicality within a risk threshold ranging from 12% to 75%.Conclusion The column chart model，constructed using variables such as smoking history，nature of injury，level of amputation，exposure time of severed finger，and compliance with medical advice on rehabilitation exercise，demonstrates a robust predictive effect for identifying poor functional recovery of severed fingers following replantation surgery.
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Corresponding Authors:
Sun Hongfei
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［1］Gürbüz K，Yontar Y.A four-year community hospital experience regarding procedures for the replantation and revascularization of fingers［J］.Jt Dis Relat Surg，2021，32(2)：383-390.
［2］谢锡洪，关助明，张振伟，等.断指再植术后患手灵活性影响因素调查［J］.实用手外科杂志，2023，37(2)：245-250.
［3］Huang X，Luo Z，Liang W，et al.Survival nomogram for young breast cancer patients based on the SEER database and an external validation cohort［J］.Ann Surg Oncol，2022，29(9)：5772-5781.
［4］Tang M，Wang H，Cao Y，et al.Nomogram for predicting occurrence and prognosis of liver metastasis in colorectal cancer：A population-based study［J］.Int J Colorectal Dis，2021，36(2)：271-282.
［5］潘生德，顾玉东，侍德.中华医学会手外科学会上肢部分功能评定试用标准［J］.中华手外科杂志，2000，16(3)：30-35.
［6］王莎，王明芳.断指再植术后血管危象的危险因素分析［J］.山西医药杂志，2020，49(24)：3454-3456.
［7］张宁，蔡飞，陈强，等.断指再植治疗手指末节完全离断伤的临床疗效及影响断指再植成活率的相关因素分析［J］.贵州医药，2022，46(3)：370-371.
［8］冯改丽，刘春霞，董亚利.断指再植术后成活率影响因素分析及护理对策［J］.血栓与止血学，2021，27(2)：322-324.
［9］李显勇，李平华，李章超.手指撕脱伤断指再植术后血管危象发生的危险因素分析［J］.实用手外科杂志，2020，34(2)：194-197.
［10］贾飞飞，韩素琴，王欣.智能手机红外线热成像系统监测移再植组织微循环的研究进展［J］.中华显微外科杂志，2021，44(5)：595-598.
［11］费佳佳，雷钧，吴婷婷，等.断指再植术后发生血管危象的相关危险因素分析［J］.浙江创伤外科，2022，27(3)：529-530.
［12］孙中平，丁明斌，张宁，等.自残性断指再植术后应用枣仁逍遥汤的疗效及预后影响因素［J］.世界中西医结合杂志，2021，16(1)：113-118.
［13］孟泽祖，鲜航，侯晓进，等.断指再植术后血管危象相关危险因素［J］.昆明医科大学学报，2021，42(1)：130-134.
［14］周湘荣，陈嘉怡，张绍海，等.断指再植术后早期指体坏死风险列线图预测模型的建立与验证［J］.实用骨科杂志，2023，29(5)：447-451.
［15］储晓新，陆飞，张娟，等.镜像理论指导下的运动处方对断指再植松解术后手功能恢复效果的影响［J］.中国医药导报，2022，19(20)：132-135.
［16］李彩红，刘莹，高婷婷.针对性三项维度护理对断指再植术患者生活能力及指关节功能的影响［J］.现代中西医结合杂志，2022，31(3)：409-412. |
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