低龄小儿YamanoⅠ区断指再植22例报告  

Digital replantation of Yamano I area in young children: a report of 22 cases

作　　者：王强[1] 巨积辉[1] 刘杰 金光哲[1] Wang Qiang;Ju Jihui;Liu Jie;Jin Guangzhe(Department of Hand Surgery, Affiliated Ruihua Hospital, Soochow University, Suzhou 215104, China)

机构地区：[1]苏州大学附属瑞华医院手外科,苏州215104

出　　处：《中华小儿外科杂志》2019年第9期826-829,共4页Chinese Journal of Pediatric Surgery

基　　金：江苏省青年医学重点人才项目(QNRC2016221).

摘　　要：目的探讨低龄小儿YamanoⅠ区断指再植的特点及治疗。方法回顾性分析2016年1月至2017年7月收治的22例25指低龄小儿YamanoⅠ区断指的临床资料。其中,男14例,女8例;年龄9个月至5岁,平均2.5岁。25指中,拇指2指,示指4指,中指9指,环指9指,小指1指。致伤原因为钝性伤中重物压砸伤8例,门夹伤5例,机器绞伤4例,锐性伤中刀切割伤5例。完全离断21指,不全离断4指。离断平面:YamanoⅠ区Ⅰ型11指,Ⅱ型8指,Ⅲ型6指。离断指体用干洁纸巾或纱布包裹。受伤至手术时间1~4h。此22例25指仅吻合动脉或动静脉,联合指端切口放血湿敷疗法进行再植,术后予患肢灯烤、预防感染、补液及冬眠治疗。结果22例25指中,23指再植指存活,2指再植指坏死。其中1指为重物压砸伤致离断,1例为机器绞伤致离断,断指均有严重皮下瘀斑。二期行坏死指体解脱,指背神经筋膜蒂皮瓣修复创面。20例断指存活患儿术后随访3个月至2年,平均5个月,再植指外形满意,功能正常。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19指,良4指。结论低龄小儿YamanoⅠ区断指细小,再植难度大,但术后外形功能恢复满意,应尽量实施再植。Objective To explore the characteristics and therapeutics of digital replantation of Yamano I area in young children. Methods From January 2016 to July 2017, retrospective analysis was performed for 22 young children (25 fingers) digital amputation of Yamano I area undergoing replantation with arterial anastomoses or arteriovenous anastomoses. There were 14 boys and 8 girls with an average age of 30 (9-60) months. There were thumb (n=2), index finger (n=4), middle finger (n=9), ring finger (n=9) and small finger (n=1). The cause of injury was blunt injury (n=17), bruise by a heavy object (n=8), crushed by door (n=5), machine twisting (n=4) and knifing (n=5). The amputation level was Yamano I type I in 11 fingers, type Ⅱ in 8 fingers and type Ⅲ in 6 fingers. Amputated finger was wrapped in a dry tissue or gauze. The time from injury to surgery was from 1 hour to 4 hours.Only arterial anastomosis or artericvenous anastomosis was performed in 25 fingers in 22 cases. Incision bleeding and wet dressing of digital tip were also applied. Focal warming, antibiotic dosing, rehydration and hibernation were offered. Results Twenty-three replantated fingers survived, Among two necrotic fingers, severe subcutaneous ecchymosis occurred in one finger of bruise injury and another of crushed injury. Both were amputated and the wounds were covered by digital dorsal neurofascial flaps during a second stage. During an average follow-up period of 5(3-24) months, gross appearance was satisfactory and functions normalized. According to the standard functional evaluating criteria of Hand Surgery Association of Chinese Medical Association, the outcome was excellent in 19 fingers and good in 4 fingers. Conclusions Amputated finger of Yamano I area is so small in young children that replantation is rather difficult. However, postoperative appearance and function of finger or thumb are generally satisfactory. Thus an amputated finger should be replantated as much as possible.

关 键 词：显微外科手术 小儿断指再植术 功能恢复 

分 类 号：R726.5[医药卫生—儿科]