手指脱套离断再植手术中远端与近端双侧侧方预减压方法的临床应用  

Application of bilateral lateral pre-decompression of distal and proximal digits in replant of degloving injury

作　　者：靳兆印 眭杰 张超前[2] 朱乔 张国平[2] 田从斌 王辉[2] 刘锦波[1] JIN Zhaoyin;SUI Jie;ZHANG Chaoqian;ZHU Qiao;ZHANG Guoping;TIAN Congbin;WANG Hui;LIU Jinbo(Department of Orthopaedics,Third Affiliated Hospital of Suzhou Medical College of Soochou University,Changzhou,Jiangsu Province 213000,China;Section II,Department of Orthopaedics,Changzhou Medical District of 904th Hospital,PLA Joint Logistic Support Force,Changzhou,Jiangsu Province 213000,China)

机构地区：[1]苏州大学医学院第三附属医院骨科,江苏常州213000 [2]中国人民解放军联勤保障部队第904医院常州医疗区骨二科,江苏常州213000

出　　处：《中华显微外科杂志》2022年第4期361-365,共5页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(81972048)。

摘　　要：目的探讨远、近端双侧侧方预减压方法在手指脱套离断再植中的临床应用。方法 2012年3月至2021年5月, 对中国人民解放军联勤保障部队第904医院常州医疗区骨二科治疗的14例(29指)手指脱套性离断患者行脱套软组织及断指再植术, 分为指尖软组织仍保留未脱套和未带指骨与甲床脱套2种类型, 采用远、近端双侧侧方指体预减压技术, 在指掌侧固有动脉双侧的脱套皮肤旁正中切开至真皮下, 作为预减压切口, 寻找可供吻合的指掌侧固有动脉和神经束远侧断端, 并与近端的指掌侧固有动脉、指掌侧固有神经分别进行吻合和缝接, 分别吻合指腹及指背静脉(直接吻合11例, 桥接吻合3例)。术后采用门诊复诊、电话和微信相结合的方式进行随访, 观察指体外形、指腹饱满程度、甲板重生情况及手指运动功能, 并按中华医学会手外科学会断指再植功能评定标准评定其功能恢复。结果术后14例29指脱套离断指体全部成活, 有4指小部分软组织坏死, 给予换药后愈合。术后随访6~36个月, 指体外形无明显萎缩, 指腹饱满, 甲板重生, 外观满意;感觉恢复良好,TPD恢复至6~10 mm, 平均7 mm;手指运动功能良好。按中华医学会手外科学会断指再植功能评定标准, 结果优23指, 良4指, 差2指, 优良率93.1%。结论对远端软组织完整、血管神经束损伤相对较轻的手指脱套性离断行断指再植, 术中采用远、近端双侧方预减压方法, 术后成活指体外观饱满, 感觉功能良好, 甲板生长, 术中及术后治疗采取个性化处理, 可获得较理想的治疗效果。Objective To explore the clinical application of distal and proximal bilateral lateral pre-decompression in replant of digit degloving injury.Methods From March 2012 to May 2021,14 patients with 29 digits had replantation surgery of degloved soft tissue and severed digits in Section II,Department of Orthopaedics,Changzhou Medical District of 904th Hospital of PLA Joint Logistic Support Force.There were 2 types of injuries:degloving injury of soft tissue but with intact digital tip,and digital tip degloving injury with intact distal phalanx and nail bed.With the technique of distal and proximal bilateral lateral pre-decompression,pre-decompression incisions were made to the subdermal on both sides of the degloved skin over the proper palmar digital arteries.From where,the distal stump of the proper palmar digital arteries and nerves for anastomosis were found and had them anastomosed with the proximal proper palmar digital arteries and proper palmar digital nerves,then anastomosed digital pulp and digital dorsal veins(11 cases were direct anastomosis and 3 cases were bridged anastomosis).Follow-up was carried out by outpatient consultation,telephone and WeChat APP.The appearance of the digit body,the shape of digital pulp,the nails grow and the motions of the digits were observed,and the Evaluation Standard of Replantation of Severed Fingers by the Society of Hand surgery of Chinese Medical Association was used to evaluate the recovery of function.Results All 29 segments of degloving digit survived.Small necrotic areas was found in 4 digits and healed after the change of dressing.The followed-up time was lasted for 3-36 months.There was no obvious atrophy found in all the digits.Appearances of digit pulp and nails were satisfactory with good sensational recovery for TPD at 6-10 mm,7 mm in average.Motions of all the repaired digits were good.According to the Evaluation Standard of Replantation of Severed Fingers by the Society of Hand surgery of Chinese Medical Association,23 digits were in excellent,4 in good and

关 键 词：脱套伤 断指 再植 预减压方法 显微外科手术 

分 类 号：R658.1[医药卫生—外科学]