拇指旋转撕脱性离断再植并Ⅰ期肌腱转位  

The replantation combined with tendon transposition to treat thumb rotation avulsion

作　　者：张辉 孙长胜 张玲玲 李文君 王婷婷 苏波 钱英俊 ZHANG Hui;SUN Changsheng;ZHANG Lingling(Department of Hand Surgery,Zhongye Hospital of Shanghai,Shanghai,201900,China)

机构地区：[1]上海中冶医院手外科,上海201900

出　　处：《实用手外科杂志》2018年第3期267-268,共2页Journal of Practical Hand Surgery

基　　金：上海市宝山区青年医学人才培养计划(项目编号:bswsyq-2015-B2)

摘　　要：目的探讨拇指旋转撕脱性离断再植并Ⅰ期肌腱转位的临床疗效。方法 2015年6月-2017年9月,对20例拇指旋转撕脱性离断伤均急诊再植并Ⅰ期肌腱转位修复指屈伸肌腱,动静脉直接吻合或移植血管桥接,神经Ⅰ期接合。结果再植并Ⅰ期转位修复再植指体全部成活,其中3例术后发生血管危象,及时探查移植血管后成活,2例指背挫伤皮肤坏死,经局部换药植皮术愈合。随访3~12个月,手指对掌、对指活动度良好,按中华医学会手外科学分会上肢部分功能评定试用标准评定:优9例,良8例,可2例,差1例,优良率85%,两点辨别觉6~10 mm。结论拇指旋转撕脱性离断急诊再植并Ⅰ期肌腱转位,可恢复拇指较好的功能。Objective To investigate the effect of replantation combined with tendon transposition on repairing the rotation avulsion injury of thumb. Methods We reviewed 20 patients who suffered from the rotation avulsion injury of thumb from June 2015 to September 2017. They each had an emergency surgery to repair the flexor and extensor tendon injury, performed direct end-end anastomosis or vascular bridging anastomosis and neural anastomosis by one-stage operation. Results All cases survived, 3 of them had vascular crisis postoperatively, treated with timely detection and vascular graft, and finally survived. Another 2 cases had skin necrosis of contusion tissues, healed with local changing dressings and skin grafting. They were followed-up for 3-12 months, all received good thumbs＂ and fingers＂ opposition functions. According to the chinese medical association of hand surgery society upper part function assessment： Excellent in 9 cases-, good in 8 cases, fair in 2 cases, poor in 1 case, and the excellent and good rate was 85%. Two-point discrimination was 6 to 10 mm. Conclusion The emergency replantation combined with tendon transposition may have a good result in the treatment of rotation avulsion of thumb and it can restore a better function of the thumb.

关 键 词：拇指 再植 旋转撕脱性离断 

分 类 号：R658.1[医药卫生—外科学]