改良神经修复在手指旋转撕脱离断再植中的应用  

A modified digital nerve repair technique in replantation of rotational avulsed fingers

作　　者：林伟栋[1] 芮永军[1] 张全荣[1] 张志海[1] 吴柯[1] 

机构地区：[1]无锡市手外科医院手外科,江苏214062

出　　处：《中华手外科杂志》2016年第2期125-126,共2页Chinese Journal of Hand Surgery

摘　　要：目的 对传统的手指旋转撕脱离断再植术中神经修复术式进行改良,评估其临床疗效.方法 自2011年8月至2015年6月,收治12例手指撕脱离断伤患者,在手指再植术中采用撕脱离断指一侧神经移植修复另一侧神经,并将切取侧神经端与另一侧神经行端侧缝合的方法修复指神经.结果 术后12例离断再植的手指均顺利存活,创口Ⅰ期愈合.随访时间12- 18个月,手指外形及功能满意,恢复痛、温觉,指腹两点分辨觉移植侧为4-9mm,感觉功能评定为S3＋-S4,端侧吻合侧为S3 - S3＋.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7例,良5例.结论 手指旋转撕脱离断伤经过清创后两侧指神经缺损并在近端找到可缝合的神经断端,采用一侧指神经移植修复另一侧神经,而切取侧神经与另一侧指神经采用端侧缝合修复,手指可恢复良好感觉,是一种可用的修复方法.Objective To modify the conventional technique for repairing digital nerve in replantation of avulsed fingers,and to evaluate its clinical outcomes.Methods From August 2011 to June 2015,12 cases of avulsed fingers were replanted.The avulsed digital nerve ou one side was harvested as a graft for repair of the digital nerve on the other side.The distal donor digital nerve was then sutured to digital nerve of the recipient side in an end-to-side fashion.Results All 12 replanted fingers survived uneventfully with primary wound healing.All the patients were follow-up for 12 to 18 months.Perfusion,appearance and function of the replanted fingers were good.Pain sensation and temperature sensation returned.Two-point discrimination was 4 to 9 mm on the graft repair side of finger pulp,equivalent to S3 ＋ to S4.Sensory recovery on the end-to-side neurorrhaphy side was S3 to S3 ＋.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 and good in 5 cases.Conclusion In replantation of avulsed fingers,sensory restoration of the pulp can be achieved by using a segment of the digital nerve from one side to graft repair digital nerve of the other side while suturing the distal donor digital nerve to the graft repair digital nerve in an end-to-side fashion.

关 键 词：指损伤 再植 神经移植 

分 类 号：R658.1[医药卫生—外科学]