显微镜下末节手指不缩短断指再植术治疗手指离断患者的效果观察  

Observation on the effect of replantation of severed finger without shortening under microscope in patients with finger amputation

作　　者：曹琦 祝海峰 朱东亮 Cao Qi;Zhu Haifeng;Zhu Dongliang(Department of Plastic Surgery,Zhoukou Huaihai Hospital,Henan Province,466000,China)

机构地区：[1]周口淮海医院整形外科,河南周口466000

出　　处：《中国医疗美容》2024年第1期22-25,共4页China Medical Cosmetology

摘　　要：目的显微镜下末节手指不缩短断指再植术在手指离断患者治疗中的应用优势,以期为此类患者治疗提供参考。方法回顾性选取2020年5月至2022年5月我院150例末节手指离断患者临床资料,根据手术方法分为研究组(78例)和常规组(72例)。研究组采用显微镜下末节手指不缩短断指再植术治疗,常规组行常规断指再植术治疗。比较两组临床疗效、手术前后应激指标[皮质醇(Cor)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)]、断指血液循环[血流速度、阻力指数(RI)]、断指恢复情况。结果研究组手术优良率94.87%、皮瓣成活率98.72%,均高于常规组的76.39%、88.89%(P<0.05);术后3d、7d研究组Cor、NE、ACTH浓度均低于常规组(P<0.05);术后1个月、3个月、6个月研究组血流速度高于常规组,RI低于常规组(P<0.05);研究组断指长度、两点辨别觉、指尖关节活动度均优于常规组(P<0.05)。结论显微镜下末节手指不缩短断指再植术治疗末节手指离断效果确切,能减轻应激反应,改善断指血流,提高皮瓣成活率,改善预后。Objective To evaluate the advantages of microscopic replantation of severed fingers without shortening in the treatment of patients with finger amputation,in order to provide reference for the treatment of such patients.Methods The clinical data of 150 patients with terminal finger amputation in our hospital from May 2020 to May 2022 were retrospectively selected,and they were divided into study group(78 cases)and routine group(72 cases)according to the surgical method.The study group was treated with microscopically unshortened severed finger replantation,and the conventional group was treated with conventional severed finger replantation.The clinical efficacy,stress indexes(cortisol(Cor),norepinephrine(NE),adrenocorticotropin(ACTH)),blood circulation[blood flow velocity,resistance index(RI)]and recovery of severed finger were compared between the two groups.Results The operative rate of the study group was 94.87%,the survival rate of the skin flap was 98.72%,which were higher than 76.39%and 88.89%in the conventional group(P<0.05).The concentrations of Cor,NE and ACTH in the study group were lower than those in the conventional group at 3 and 7 days after surgery(P<0.05).At 1 month,3 months and 6 months after operation,the blood flow velocity in the study group was higher than that in the conventional group,and the RI was lower than that in the conventional group(P<0.05).The severed finger length,two-point discrimination perception and fingertip joint motion in the study group were better than those in the conventional group(P<0.05).Conclusion Replantation without shortening of severed finger under microscope can reduce stress response,improve blood flow of severed finger,increase the survival rate of skin flap and improve prognosis.

关 键 词：手指离断 末节手指 不缩短断指再植术 显微镜 应激反应 血液循环 预后 

分 类 号：R658.1[医药卫生—外科学]