屈膝踏足逆行再植法在踇趾旋转撕脱离断再植术中的应用  

An operative position of foot stepping and knee bending in toe replantation for avulsed and fractured great toe

作　　者：姚红毅 范永辉 李建峰 裴建锋 段杰斌 张克伟 梁康雄 李宏胤 王鹏飞 赵艳兵 滕国栋[2] YAO Hongyi;FAN Yonghui;LI Jianfeng;PEI Jianfeng;DUAN Jiebin;ZHANG Kewei;LIANG Kangxiong;LI Hongyin;WANG Pengfei;ZHAO Yanbing;TENG Guodong(Taiyuan Great Wall Orthopaedics and Hand Surgery Hospital,Taiyuan 033001,China;The Hand Surgery Centre,The 971th Hospital of the Chinese People 5 Liberation Army,Qingdao,Shandong Province 266071,China)

机构地区：[1]太原长城骨伤手外科医院,太原033001 [2]中国人民解放军第971医院,全军手外科中心,山东青岛266071

出　　处：《中华显微外科杂志》2022年第1期50-54,共5页Chinese Journal of Microsurgery

摘　　要：目的总结屈膝踏足逆行再植法在踇趾旋转撕脱离断再植术的优点和缺点及应用体会.方法2016年1月-2021年6月,采用屈膝踏足逆行再植法对11例旋转撕脱性离断踇趾行断趾再植术,其中男10例,女1例.年龄18~50岁,平均32岁.致伤原因:机器皮带绞伤5例,碾压伤4例,车祸伤2例.受伤部位:左踇趾4例,右踇趾7例,均为完全离断,均伴有屈伸肌腱近端抽出.术后患者均获随访,其中门诊随访7例,电话随访2例,微信随访2例.结果术后9例踇趾完全成活,2例踇趾坏死.断趾再植成活率为81.8%(9/11),手术时间2~3 h,平均2.5 h.X线片复查示,术后8~12周成活踇趾骨折及关节融合均一期愈合.随访时间3~18个月,平均10.5个月.成活踇趾外形饱满,趾甲生长良好.末次随访时踇趾端静态TPD为8~12mm,平均10 mm.患足行走及跑步无影响.结论采用屈膝踏足逆行再植法行踇趾旋转撕脱性离断再植术具有视野暴露良好、镜下操作方便、可缩短手术时间、再植成活率高的优点.Objective To summarise the advantages and disadvantages of applying the method of retrograde replantation with an operative position of foot stepping and knee bending for replantation of rotational avulsed and fractured great toes.Methods From January 2016 to June 2021,11 rotational avulsed and fractured great toes were replanted with the method of retrograde replantation in an operative position of foot stepping and knee bending.Of the II patients,10 were males and 1 was female,aged 18 to 50 years old with an average of 32 years old.Causes of injury:5 of driving belt,4 of machinery crush and 2 of car accident.Injury sites:4 on left great toes and 7 on right great toes.All of the injuries were with fracture and exposure of proximal tendons of flexor and extensor.Seven patients had the follow-up reviews by outpatient clinic visiting,2 over mobile phone and 2 via WeChat.Results After surgery,9 great toes completely survived and 2 great toes had necrosis.The survival rate of toe replantation was 81.8%(9/l 1).The operation time was 2 to 3 hours,with an average of 2.5 hours.Postoperative X-ray film showed that 8 to 12 weeks after the operation,the fracture and joint fusion were healed at first stage in the survived toes.All patients were entered in follow-up for 3 to 18 months with 10.5 months in average.The survived great toes were plump and the toenail grown well.At the final follow-up,the static TPD at the toes was 8-12 mm,with an average of 10 mm.There was no effect shown on either walking or running.Conclusion The retrograde replantation method with an operative position of foot stepping and knee bending for great toe replantation has the characteristics of a good field of view and convenient in operation under microscope,a short operation time,and a high survival rate of replantation.

关 键 词：踇趾 离断伤 断趾再植 逆行再植 屈膝踏足 

分 类 号：R658.1[医药卫生—外科学]