拇指旋转撕脱性离断再植方法的改良  

The improvement of a surgery method for replantation of the whirl avulsion of thumb

作　　者：刘刚义[1] 席志峰[1] 王从虎[1] 朱修文[1] 张洁[1] 宋涛[1] 王芳[1] 

机构地区：[1]中国人民解放军第3医院手外科,陕西宝鸡721006

出　　处：《实用手外科杂志》2011年第2期109-110,120,共3页Journal of Practical Hand Surgery

摘　　要：目的介绍改良拇指旋转撕脱性离断再植方法的临床经验。方法对11例旋转撕脱性离断的拇指．采用移位环指掌侧总动脉神经束的方法重建拇指的血循环及感觉，并与以往的方法进行对比。结果11例再植指全部成活，其中1例术后第2d发生血管危象，经探查后解除。随访6～18个月，再植拇指的外形良好，恢复了对指及抓捏功能；依中华医学会手外科学会上肢部分功能评定试用标准：优7例，良2例，中2例，优良率82％；拇指的两点辨别觉为5~9mm。供侧指腹感觉恢复满意，无功能影响。结论采用改良后的再植方法，不仅最大限度重建了旋转撕脱性离断拇指的血循环及感觉功能．而且供区损失相对减少，是一种安全可靠、疗效显著的方法，值得推广。Objective To introduce a new surgery method for replantafion of the whirl avulsion of thumb. Methods 11 thumbs with whirl avulsion were replanted by using the second digital artery and nerve tracts to reconstruct the blood circulation and sense. Results All fingers survived successfully. Vascular crisis only occurred in 1 case on the second day after surgery, but was relieved by surgical exploration. All fingers presented with the satisfactory appearance and recovered the functions such as digital opposition, grasp and pinch in 6 to 18 months postoperative follow-up. According to the functional assessment criteria of upper limb issued by Society of Hand Surgery of Chinese Medical Association, 7 cases were excellent （82%）, 2 cases were good and 2 cases was mediocre. Two-point discrimination of thumb ranged from 5~9mm. The sense of finger pulp of donor side recovered satisfactorily and there was no functional impairment. Conclusion The improved method for replantation of the whirl avulsion of thumb not only reconstructed the blood circulation and sense to the maximum, but also damaged less on the lesion of donor site, which was a safe and remarkably effective surgery and deserved a further generalization.

关 键 词：拇指 再植 旋转撕脱性离断 改良 

分 类 号：R658.1[医药卫生—外科学]