挤压性断指再植的几个技术问题探讨  

Successful replantation of crush severed fingers: key surgical techniques explortion

作　　者：李宗军[1] 肖春凌[1] 康庆林[2] 

机构地区：[1]山东省新汶矿业集团公司中心医院骨二科,山东新汶271233 [2]上海市第六人民医院骨科

出　　处：《实用手外科杂志》2008年第4期198-200,共3页Journal of Practical Hand Surgery

摘　　要：目的探讨手指挤压离断再植的手术方法及影响成活的因素和对策。方法对65例82指挤压指完全离断的病例进行再植,为提高手术的成功率,术中尽可能多的吻合指背及指掌侧静脉,对血管挫伤严重的手指采用血管移植、血管神经束转位、带血管皮瓣转移等方法进行再植修复;根据术后血小板活化的程度或临床表现,用适量尿激酶以纠正高血凝状态,以提高毛细血管的灌注。结果82个断指中成活78指,成活率95.1%,42例得到随访,随访时间6个月～3年,平均1年5个月,手指外形及感觉、运动功能恢复满意。按中华医学会手外科学会上肢部分功能评定试用标准[1]评定,优52指,良21指,差5指,优良率93.6%。结论挤压伤断指只要手指外形未完全破坏,远端可寻见能吻合的血管,通过血管移植、血管神经束转位、静脉皮瓣转移等方法,应尽可能的进行再植修复,有较高的再植成活率。Objective To discuss the replantative operation of the crush severed fingers and the influencing factors and countermeasures of their survival.Methods Replantation was carried in 82 fingers of 65 cases with extrusive severed fingers.To improve the successful operative rate, anastomosed should be as much as possible,and the severed fingers with the severe vascular contusion should be repaired by the way of the vascular transplantation,the neurovascular bundle translocation, the transference of arterialized flap and so on, and the use of the proper amount of urokinase to correct the high-coagulation condition is to improve the capillary perfusion according to the levels of platelet activation and the chnical manifestation.Results 78 fingers among the 82 fingers survived, with 95.1% of success rate. Follow-up period ranged from 6 months to 3 years in 42 cases,and the mean follow up time was 17 months. The appearance and function of the fingers was satisfactory. According to provisional functional assessment criterion for upper hmbs issued by Chinese Society of Hand Surgery, super rate occurred in 52 fingers ,good in 21 fingers1, poor in 5 figures. The total super and good rate was 93.6%.Conclusion If the appearance of the extrusive severed fingers were not destroyed completely and the vascular used for anastomoses still existed, replantation by the way of the vascular transplantation,the neurovascular bundle translocation, the transference of arterialized flap and so on,can achieve high survival rate.

关 键 词：挤压伤 手指离断 再植 

分 类 号：R658.1[医药卫生—外科学]