肢体毁损伤保肢治疗的体会  

Experience of limb salvage therapy for limb destruction injury

作　　者：王才波 金德镐 胡召坤 胡佳俊 WANG Caibo;JIN Dehao;HU Zhaokun(Department of Hand Surgery,Zhongshan Orthopaedic Hosp让al,Nantong,Jiangsu,266000,China)

机构地区：[1]南通中山骨科医院手外科

出　　处：《实用手外科杂志》2019年第4期430-433,共4页Journal of Practical Hand Surgery

摘　　要：目的通过对肢体毁损伤保肢治疗的回顾性总结,探讨治疗过程中的经验与教训。方法 2015年6月-2018年10月,对10例肢体毁损伤患者进行保肢治疗,急诊行重建肢体血运与固定骨折,Ⅱ期行软组织修复,术后观察创面愈合及肢体的功能恢复情况。结果保肢成功8例,术中截肢1例,术后保肢失败截肢1例。保肢成功后的患肢,随访0.6~1.5年,均有保护性感觉恢复,无疼痛,上肢以中华医学会上肢断肢再植功能评定试用标准评定:优2例,良3例,可3例。下肢行走稍有跛行3例,明显跛行1例,均无需辅助工具可独立行走。大腿近端截肢病例安装假肢后需拐杖辅助行走,小腿中段截肢病例安装假肢后可独立行走。结论对肢体毁损伤的治疗,术前应谨慎进行保肢评估,让患者及家属参与保肢与截肢的决策过程中,做到细心保肢,果断截肢。Objective To discuss the experiences and lessons in the treatment of limb destruction injury by reviewing the treatment of limb preservation. Methods From June 2015 to October 2018, 10 patients with limb destruction injury were treated for limb preservation, the emergency treatment was performed to reconstruct the blood flow and fixe fracture of the limb, the second-phase treatment was repairing soft tissue, and the wound healing and functional recovery of the limb were observed after surgery. Results Eight cases were successfully preserved, 1 case was amputated during surgery, and 1 case was amputated after operation. After the successful maintenance of the limb, with the follow-up of 0.6 to 1.5 years,there was protective feeling recovery, no pain. The upper limb was evaluated with the Chinese Medical Association upper limb replantation function evaluation test criteria: excellent in 2 cases, good in 3 cases.The lower extremity had the slight limp in 3 cases, the apparent limp in 1 case, did not need the auxiliary tool to walk independently. In the proximal thigh amputation case, a prosthetic leg was installed to assist the walking. In the middle thigh amputation case, a prosthetic leg was installed to walk independently.Conclusion The treatment of limb destruction injury careful limb preservation assessment should be performed preoperatively, patients and family members participate in the decision-making process of limb preservation and amputation, we should a chieve careful limb preservation and decision amputation.

关 键 词：四肢 毁损伤 保肢 

分 类 号：R658[医药卫生—外科学]