不同方法治疗全手脱套伤的效果比较  

Comparison the effects of different methods in treating complete hand skin tissue of degloving injury

作　　者：丁德伟 王洪财 王丽华 王春梅 

机构地区：[1]广东省东莞仁康医院手足显微外科,广东东莞523952 [2]广东省东莞仁康医院护理部,广东东莞523952 [3]广东省东莞仁康医院整形美容中心,广东东莞523952

出　　处：《中国当代医药》2016年第13期19-22,25,共5页China Modern Medicine

基　　金：广东省东莞市科技计划医疗卫生类科研一般项目(2015105101042)

摘　　要：目的 探讨双侧足趾联合一期修复在全手脱套伤中的应用效果。方法 选取我院2010年1月-2015年1月收治的10例全手脱套伤患者,行双侧足踇趾腓侧皮瓣加第4趾甲皮瓣瓦合双手指,带双足背皮瓣覆盖手背及股前外侧皮瓣覆盖手掌创面治疗（A组）;另选取我院同期采用传统腹部袋状皮瓣修复的8例患者作为对照组（B组）,比较两组患手感觉恢复情况,总主动活动度（ROM）、握力、静态两点辨别觉（s2PD）和返回正常工作时间。结果 A组10例患者,成活9例,坏死1例,其中1例术后24 h内发生静脉危象,给予二期皮瓣修复后痊愈,皮瓣修复后治愈,再造手指存活,但外观较回植者差。患者均获得随访,时间6-24个月,指端两点分辨觉为4.8 mm。B组8例患者中成活7例,坏死1例,A组患者术后手指感觉恢复和主动活动度均明显优于B组,差异有统计学意义（P〈0.05）;A组患者返回正常工作岗位的时间明显短于B组,差异有统计学意义（P〈0.05）。结论 双侧足趾联合一期修复可恢复缺损手指的外形及功能,疗效满意,是多个手指脱套伤治疗的较好选择。Objective To explore the effects of bilateral toes combined with primary repair in treating complete hand skin tissue of degloving injury. Methods 10 hands skin tissue of degtoving injury patients from January 2010 to Jan- uary 2015 of our hospital were given double parapodum toe phil side flap with the fourth toenail skin flap in both hands,with double dorsalis pedis flap to cover the back of hand and femoral anterolateral flap covering of the palm of hands （group A）.8 cases were given traditional abdominal pocket flap repair in our hospital at the same term were se- lected as control group （group B）.Hand feeling recovery situation,active total range of motion （ROM）,grip strength,static two-point discrimination（s2PD）,and time of going back to work between two groups were compared. Results 10 patients in group A,with 9 cases survived and 1 necrosis;1 cases appeared venous crisis within 24 h after operation and recov- ered after given phase I1 flap repair, cured after skin flaps repaired,the reengineering finger survival but the appearance was less than replantation patients.All patients got following up and the time from 6 to 24 months.Two finger tip reso- lution was 4.8 mm.10 patients in group B,with 9 cases survived and 1 necrosis.The hand feeling recovery situation and ROM in group A was obvious better than that of group B respectively with statistical difference（P〈0.05）.The time of go- ing back to work in group A was obvious shorter than that of group B with statistical difference （P〈0.05）. Conclusion Bilateral toes combined with primary repair can repair the appearance and function of finger defects,with good effects.It is a good choice for the treatment of hand skin tissue of degloving injury.

关 键 词：指损伤 手部脱套伤 趾关节 一期修复 移植 

分 类 号：R622[医药卫生—整形外科]