损害控制下的断指再植术  

Treatment of digital replantation and shifted replantation under damage control

作　　者：邢进峰[1] 丁伟航[1] 陈欢欢[1] 孙西涛[1] 沈金明[1] 童良春[1] 李飞[1] 徐海孺[1] 蒋云甫[1] 黄杰烽[1] 

机构地区：[1]浙江中医药大学附属第一医院骨伤科,杭州310018

出　　处：《中华手外科杂志》2015年第2期110-112,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨损害控制在严重多发伤伴手指离断伤患者中的临床应用。方法多发伤患者2例，严重度评分（ISS）≥25分，病例1：左顶部硬膜下血肿，左顶骨骨折，气颅，左顶部头皮缺损，左示、中指指深浅屈肌腱断裂，左前臂背伸肌群断裂，左手拇指、环指、前臂多处皮肤挫裂伤；右尺骨上段开放性骨折，右前臂背伸肌群断裂，右尺神经损伤伴右拇指离断伤。病例2：左侧肺挫伤伴血气胸，左侧多发肋骨骨折，颈，椎体骨折，右手毁损伤，头皮挫裂。2例患者在损伤早期均采用损害控制理念，多科协作进行抢救，离断指体无菌纱布包扎后放入无菌手套内置于2℃～4℃冰箱保存。病例1于伤后63h试行原位再植；病例2于伤后103h试行中指移位至拇指、环指移位至示指再植。结果病例1再植指完全存活，半年后复查右拇指伸屈良好，痛觉、触觉迟钝。病例2移位再植指存活，近端部分皮肤坏死，经坏死皮肤切除、换药、植皮，最终创面愈合，但伸屈功能欠佳。结论损害控制可有效提高严重多发伤患者的早期抢救成功率，提高生存率，延期再植和移位再植可有效降低严重多发伤伴手指离断伤患者的致残率。Objective To investigate the clinical application of damage control in severe multiple trauma with amputation injury at fingers. Methods Two cases of multi-trauma were included in this study, with ISS （Injury Severity Score） higher than 25. In case 1, the patient was diagnosed as left parietal subdural hematoma, left parietal bone fractures, intracranial pneumatosis, scalp defect in the left parietal area, rupture of superficial and deep flexor tendon of the left index and middle finger, rupture of the left extensor muscle, right ulnar nerve injury and amputation injury on the right thumb. In case 2, the patient were diagnosed as the left pulmonary contusion with hemopneumothorax, multiple rib fractures, the 7th cervical spine fracture, injuries on the right hand and scalp laceration. Both patients were treated under damage control and multi-department cooperation. Severed digits were preserved with sterile gauze sterile gloves at 2℃ to 4℃. The first patient was treated with in situ replantation within 63 hours after the injury. The second patient was treated with shifted replantafion within 103 hours, the middle finger was shifted to reconstruct the thumb and the ring finger was shifted to reconstruct the index finger. Results All the fingers in ease 1 survived, with satisfying flexion and extension function but unsatisfying sense of pain and touch. The shifted fingers all survived in case 2. Necrosis occurred partly on the proximal margin of the shifted fingers, while the defect healed after debridement and skin grafting. Recovery of finger flexion and extension was unsatisfying. Conclusion Damage control could raise the early rescue success rate of severe multiple injury and survival rate effectively. Delayed replantafion and shifted replantation could reduce disability rate of patients with severe multiple trauma with severed finger injury.

关 键 词：再植术 指损伤 严重多发伤 损害控制 

分 类 号：R658.1[医药卫生—外科学]