青少年及儿童末节压砸断指再植的临床特点  

The clinical features of crushed amputations at the distal fingers in adolescence and children

作　　者：于志军 李庆泰[2] 纪柳[2] 房嘉宾[2] 刘沐清[2] 秦永平[2] 梁波[2] 

机构地区：[1]玉田县鸦鸿桥中心卫生院,河北玉田064102 [2]清华大学玉泉医院手外科,北京100049

出　　处：《实用手外科杂志》2012年第1期35-37,共3页Journal of Practical Hand Surgery

摘　　要：目的探讨青少年及儿童末节不同节段压砸断指再植方法的选择及临床疗效。方法2006年2月～2010年11月，对85例134指，年龄1～25岁的患（儿）者，因压砸致不同离断节段的末节断指．按照Ishikawa末节断指分区的血管特点，显微镜下行断指再植术。结果本组134指成活127指．成活率94．7％。术后随访4个月～3年，其中3指Ⅳ区断指因未成年骨骺未闭合，骨骺组织损伤较重．发育稍侧偏畸形、短小；4指甲根部损伤指甲不平整，其余再植指指甲、指腹外形良好。按中华医学会手外科学会断指再植功能评定试用标准评定：优63指，良55指，差9指；优良率达92．9％。结论针对青少年及儿童末节断指的不同离断节段的压砸伤，只要熟练掌握末节断指不同区域的血管特点，选择相应的再植方法．细心清创和精确吻合血管．就能提高再植成活率．降低残指率．从而恢复指体良好的外观及功能．Objective To investigate the clinical features of crushed amputations at the distal fingers in children, summarize the strategies for handling the vessels in replantation and assess the clinical outcomes. Methods From February 2006 to November 2010, 134 fingers in 85 patients of 1 to 25 years old were replanted. The vessels were anastomosed under the microscope according to Ishikawa＇s classification. Results 127 out of the 134 replanted fingers survived.The survival rate was 94.7%. Postoperative follow- up ranged from 4 months to 3 years. Satisfactory results in the contours of finger nail and pulp in all the survived cases, except for mild lateral deviation deformity in 3 cases due to the crushing injury of epiphysis in zone IV.According to the functional evaluation criteria formulated by Chinese Hand Surgery Society, Results were excellent in 63 cases, good in 55 cases, and poor in 9 cases.The overall excellent- good rate was 92.9%. Conclusion Blunt injury is the common destroy of the distal finger amputation in children.Satisfactory results can be obtained provided that the surgeon in familiar with the vascular anatomy of the distal finger, and that meticulous debridement and precise vascular anastomosis was done. Therefore.the crushed amputations at the distal fingers in children are also the candidates for replantation and should be replanted aggressively.

关 键 词：显微外科 再植术 压砸 

分 类 号：R658.1[医药卫生—外科学]