拇指旋转撕脱离断伤再植术式改进的探讨  

A modified replantation technique for thumb rotational avulsion amputation

作　　者：周晓[1] 芮永军[1] 薛明宇[1] 许亚军[1] 寿奎水[1] 卜凡玉[1] 

机构地区：[1]无锡市手外科医院手外科,214062

出　　处：《中华手外科杂志》2014年第3期201-202,共2页Chinese Journal of Hand Surgery

摘　　要：目的对传统的拇指旋转撕脱离断伤再植术式进行改进，并评估其近期临床疗效。方法2008年8月至2012年2月，对9例拇指撕脱离断伤实施断指再植。男7例，女2例；年龄14～68岁，平均33．5岁。离断平面均为近节指骨基底以远。根据软组织情况，适当短缩指骨后采用克氏针内固定，通过原隧道将屈伸肌腱在肌腱肌腹结合处，采用肌腱原位包埋缝合法处理撕脱肌腱；同时在前臂同一切口取浅静脉移植修复拇指指动脉及吻合多条静脉；双侧撕脱的指固有神经与掌骨背侧的指背神经修复重建感觉。结果本组9例术后伤口均工期愈合，离断拇指再植成功，术后未出现血管危象。患者均获得随访，时间9个月至2年。拇指血运良好，再植拇指外形良好，指腹饱满。对指功能满意。末节指腹两点分辨觉为8～12mm。根据中华医学会手外科学会断指再植功能评定试用标准评定再植断指功能：优7例，良1例，可1例。结论通过撕脱肌腱原位包埋缝合结合同一切口静脉移植重建离断拇指血运，缝合指神经与指背神经重建拇指的感觉，是急诊处理拇指撕脱离断伤的理想方法之一。Objective To modify the conventional replantation technique for thumb rotating avulsion amputation, and to evaluate its short term clinical outcomes. Methods From August 2008 to February 2012, 9 amputated thumbs with rotation avulsion were replanted. Among them, 7 patients were male and 2 were female. Their ages ranged from 14 to 68 years, with an average of 33.5 years. The amputation level of each thumb was proximal phalanx base. During the operation, the phalanx was shortened according to the extent of soft tissue injury and fixed with Kirschner wires. The flexor and extensor tendons were channeled through their original tunnel, embedded in the tendon-muscle junction and sutured in situ. A superficial vein was harvested from the same incision and used to bridge the dorsal carpal branch of the radial artery and both proper digital arteries of the thumb. Multiple veins were anastomosed. Both digital nerves were coapted to the dorsal superficial branch of the radial nerve for sensory restoration. Results All replanted thumbs in 9 cases survived completely with primary wound healing. There was no postoperative vascular crisis. All the patients were follow-up for 9 to 24 months. Perfusion and appearance of the replanted thumbs were good. Thumb opposition was satisfactory. Two-point discrimination was 8 to 12 mm on thumb pulp. According to the criteria for functional assessment of replanted fingers issued by the Hand Surgery Society of Chinese Medicine Association, the results were excellent in 7 cases, good in 1 case, and moderate in 1 case. Conclusion In situ embedding suture of avulsed tendons, vein graft from the same incision for blood vessel reconstruction, and digital nerve coaptation to the dorsal superficial radial nerve branch for sensory restoration are steps to an ideal replantation of avulsion amputated thumbs.

关 键 词：拇指 创伤和损伤 再植 

分 类 号：R658.1[医药卫生—外科学]