前瞻性手功能评定对手部严重复合伤手术治疗的指导意义  

The guiding significance of prospective hand function assessment for repairing multifinger complex injury of hand

作　　者：王科杰 滕晓峰 阮健 WANG Kejie;TENG Xiaofeng;RUAN Jian(Department of Hand Surgery,Ningbo 6th Hospital,Ningbo 315000,China)

机构地区：[1]宁波第六医院手外科,浙江宁波315000

出　　处：《全科医学临床与教育》2022年第6期497-500,共4页Clinical Education of General Practice

摘　　要：目的根据手功能评定结果制定个性化的手术方案,探讨手功能评定对手部复杂损伤的前瞻性指导意义。方法选择39例手外伤患者,在进行手术前,设计不同的手术方案,通过前瞻性手功能评定方法,评估每种手术方案后患肢所获得的手失能百分比结果,根据手失能百分比结果选择适当的手术方案,确定优先保留指或优势指,个性化地设计利用损伤严重的废弃指或劣势指移位修复保留指或优势指,使手功能最大化。结果39例患者中,选择吻合血管的游离复合组织移植及手指再植28例,选择带蒂皮瓣移位修复及手指移位重建11例。皮瓣及手指全部成活,随访6~12个月,术后上肢部分功能评定:优5例、良21例、可8例、差5例。结论治疗手部多个指体复杂损伤时,根据手功能评定方法,前瞻性评估手部功能,可更有效地制定合理的手术方案,充分利用废弃指或劣势指的组织移位重建指体、修复组织缺损,最大程度保留手部功能,减少多余供区,避免多次手术,减少患者痛苦,缩短治疗时间。Objective To make a personalized operation plan according to the evaluation result of hand function,and explore the prospective guiding significance of hand function assessment for complex injury of the hand.Methods A total of 39 cases with multifinger complex injury of hand were selected.Before the operation,different surgical schemes were designed.The hand disability results of each operation scheme were evaluated through the hand function evaluation standard.According to the hand disability results,an appropriate surgical scheme was selected to determine the priority reserved finger or superior finger,and the severely damaged abandoned finger or inferior finger was designed and used to repair the reserved finger or superior finger,thus to maximize hand function.Results In 39 cases,28 cases received vasoanastomotic finger transplantation of free composite tissue or fingers and 11 cases chose finger reconstruction using the pedicled flaps.All the flaps and fingers were survived.Followed up for 6 to 12 months,there were 5 excellent cases,21 good cases,8 acceptable cases and 5 poor cases according to the upper limb function trial evaluation standard of hand surgery society of chinese medical association.Conclusion When treating complex injuries of multiple fingers of the hand,prospectively evaluating hand function according to the hand function evaluation method can make more reasonable and effectively operation plan,and make full use of the displaced tissue(the disused or inferior fingers)to reconstruct the finger and repair the defect of tissue.And it can maximize the hand function,reduce the excess blood supply area,avoid reoperation,and shorten the treatment time.

关 键 词：手功能评定 手复合伤 移位 

分 类 号：R658.2[医药卫生—外科学]