手桡侧毁损伤分型初步探讨  

A preliminary study on the classification of mutilated injuries of the radial side of the hand

作　　者：廖坚文[1] 张振伟[1] 庄加川[1] 余少校[1] 陈泽华[1] 关助明[1] 蔡凌[1] 林慧鑫[1] 

机构地区：[1]广州医学院附属深圳沙井医院手外科,深圳518104

出　　处：《中华手外科杂志》2010年第4期216-218,共3页Chinese Journal of Hand Surgery

基　　金：广东省深圳市卫生局科技基金资助项目（2006024）

摘　　要：目的探讨手桡侧毁损伤分型及一期修复的方法与临床效果。方法回顾性研究总结129例手桡侧毁损伤患者，将手桡侧毁损伤分为五型：Ⅰ型：拇指毁损（54例）；Ⅱ型：拇指毁损并虎口皮肤缺损（33例）；Ⅲ型：拇指毁损、虎口皮肤缺损并示指毁损（10例）；Ⅳ型：拇指毁损、虎口皮肤缺损、示指毁损并中指毁损（29例）；Ⅴ型：拇指毁损、虎口皮肤缺损、示指毁损、中指毁损并手掌桡侧毁损（3例）。根据分型的不同，分别采用游离足趾移植或残存手指异位再植方法再造拇指，以股前外侧、足背或上臂外侧皮瓣等修复手桡侧创面。结果术后129例移植组织存活128例，成活率为99．2％。随访时间为1～4年，手功能恢复按中华医学会手外科学会上肢部分功能评定试用标准评价：优46例，良61例，可19例，差3例，优良率为82．9％。结论对手桡侧毁损伤，根据其分型不同，分别选用不同术式行一期修复与功能重建，效果良好。Objective To investigate the classification of mutilated injuries of the radial side of the hand and the clinical outcomes of primary repair. Method A retrospective study of 129 cases of mutilated injuries of the radial side of the hand was carried out. The injuries were divided into five types. In type Ⅰ the mutilated injury only involved the thumb （54 cases）. In type Ⅱ the mutilated thumb was accompanied by skin defect of the first web space （33 cases）. In type Ⅲ both the thumb and index finger were mutilated along with skin defect of the first web space （ 10 cases）. Type Ⅳ involved mutilated injuries of the thumb, index finger and long finger, and skin defect of the first web space （29 cases）. In Type Ⅴ the mutilated injuries involved the thumb, index finger, long finger and the radial side of the palm, along with skin defect of the first web space （3 cases）. According to the different injury types, various reconstruction strate^es were used including toe-to-thumb transfer or heterotopie replantation of the remaining finger for thumb reconstruction, anterolateral thigh flap, dorsalis pedis flap or lateral arm flap for resurfacing of the radial side of the hand. Results Out of the total 129 cases, the transferred flaps and toes or heteretopieally replanted fingers in 128 cases survived, The overall survival rate was 99.2%. The patients were follow-up for 1 to 4 years. According to the provisional functional assessment criteria for upper llmb issued by the Hand Surgery Society of Chinese Medical Association, the functional recovery was rated as excellent in 46 eases, good in 61 cases, acceptable in 19 cases, and poor in 3 cases. The overall excellent and good rate was 82.9%. Condu^on Classification of mutilated injuries of the radial side of the hand is useful for the selection of proper operative procedures. The clinical outcome is satisfactory after functional reconstruction with primary repair.

关 键 词：手 创伤和损伤 修复外科手术 分型 

分 类 号：R658.2[医药卫生—外科学]