全手皮肤脱套伤两种治疗方式的疗效比较  

EFFECTIVENESS COMPARISON BETWEEN TWO KINDS OF PROCEDURES FOR TREATMENT OF TOTALLY DEGLOVED HAND

作　　者：刘育杰[1,2] 屈志刚[2] 孙乐天[2] 焦鸿生[2] 刘亚平[2] 丁小珩[2] 曹学成[1] 

机构地区：[1]济南军区总医院骨创伤外科,济南250031 [2]解放军第401医院全军手外科中心

出　　处：《中国修复重建外科杂志》2014年第8期973-976,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 比较游离足趾移植联合腹部皮瓣与传统腹部袋状皮瓣治疗全手皮肤脱套伤的疗效。 方法 回顾2005年1月－2012年1月收治的18例全手皮肤脱套伤患者临床资料，其中8例采用传统腹部袋状皮瓣修复（A组）；10例采用带足背皮瓣的（足母）甲瓣（7例）或第2趾（3例）游离移植，联合腹部S形瓦合皮瓣修复（B组）。两组患者性别、年龄、致伤原因、损伤手别及程度、受伤至手术时间比较，差异均无统计学意义（P 〉 0.05）。比较两组患手感觉恢复情况，静态两点辨别觉（static two-point discrimination，s2PD）、握力、总主动活动度（active total range of motion，ROM）和返回工作时间。结果术后两组皮瓣均成活；B组1例术后2 d出现（足母）甲瓣血管危象，经对症处理后成活。两组患者均获随访，随访时间12～24个月，平均16个月。末次随访时，B组ROM、拇指s2PD均优于A组，返回工作时间较A组显著缩短，差异均有统计学意义（P 〈 0.05）；但两组患手握力及其他手指s2PD比较，差异均无统计学意义（P 〉 0.05）。 结论游离足趾移植联合腹部皮瓣治疗全手皮肤脱套伤，手术操作简便，手术次数少，疗效优于传统腹部袋状皮瓣修复术。Objective To compare the effectiveness between toe transfer combined with an abdominal flap and bag-shaped abdominal flap for treatment of totally degloved hand. Methods Between January 2005 and January 2012, 18 patients with totally degloved hand were treated by two kinds of techniques. Those patients were divided into 2 groups according to the technique. The bag-shaped abdominal flap was used in 8 cases （group A）, and toe transfer with a dorsalis pedis skin flap combined with abdominal S-shaped tile-joint subdermal vascular network flaps was performed in 10 cases （group B）. There was no significant difference in gender, age, injury cause, injury degree, and interval between injury and operation between 2 groups （P 〉 0.05）. The static two-point discrimination （s2PD）, grip power of the reconstructed hand, time of returning to work, and active total range of motion （ROM） of the operated finger were compared between 2 groups to assess the effectiveness. Results All flaps and skin grafts survived in 2 groups. One flap suffered vascular crisis at 2 days after operation and survived after surgical exploration in group B. All patients were followed up 12-24 months （mean, 16 months）. At last follow-up, group B showed a better recovery of s2PD of the thumb and ROM, and shorter time of returning to work than group A （P 〈 0.05）, but no significant difference was found in grip power of the reconstructed hand and s2PD of the other fingers between 2 groups （P 〉 0.05）. Conclusion The technique of toe transfer

关 键 词：全手皮肤脱套伤 腹部袋状皮瓣 足趾游离移植 

分 类 号：R658.2[医药卫生—外科学]