大肢体离断再植临床治疗的回顾性分析  

Retrospective analysis of clinical treatment for replantation of major limbs amputation

作　　者：滕志成 王凯 巨积辉[1,2] 刘跃飞 金光哲[1,2] 唐林峰 柳志锦[1] Teng Zhicheng;Wang Kai;Ju Jihui;Liu Yuefei;Jin Guangzhe;Tang Linfeng;Liu Zhijin(Department of Hand Surgery,Suzhou Ruihua Orthopedic Hospital,Suzhou 215104,China;Suzhou Medical College of Suzhou University,Suzhou 215123,China)

机构地区：[1]苏州瑞华骨科医院手外科,苏州215104 [2]苏州大学苏州医学院,苏州215123

出　　处：《中华手外科杂志》2023年第6期515-519,共5页Chinese Journal of Hand Surgery

基　　金：苏州市科教兴卫临床重点病种诊疗技术专项项目(LCZX202130);苏州市重点学科(SZXK202127)。

摘　　要：目的探讨创伤后大肢体离断再植手术的临床疗效及治疗体会,总结大肢体离断再植的适应证及改进方法。方法自2017年4月至2022年7月,我院收治大肢体离断患者44例,完成再植43例。术后观察再植肢体伤口愈合及存活情况,定期随访再植肢体功能恢复情况。结果术后41例(95.3%)再植肢体存活,15例(34.9%)创面分泌物培养出细菌,28例(65.1%)采取植皮或皮瓣修复创面,9例(20.9%)行功能重建。术后41例再植存活患者随访时间为3~42个月,平均17.9个月。根据陈中伟断肢再植评定标准:优5例,良24例,可11例,差1例。结论大肢体离断再植较为复杂。必须保证患者生命安全,排除再植禁忌证,选择安全快速的组织修复方式,尽力缩短肢体缺血时间,术后避免发生严重并发症,并进行序贯康复治疗,以提高术后肢体成活率和功能恢复程度。Objective To explore the clinical efficacy and treatment experience of replantation surgery for major limbs amputation after trauma,and summarize the indications and improvement methods for replantation of major limbs amputation.Methods From April 2017 to July 2022,our hospital admitted 44 patients with major limbs amputation and completed replantation in 43 cases.The wound healing and survival of the replanted limbs after surgery were observed,and regular follow-up on the functional recovery of the replanted limbs was conducted.Results After surgery,41 cases(95.3%)of limb replantation survived,15 cases(34.9%)of wound secretions cultured bacteria,28 cases(65.1%)underwent skin grafting or flap repair of the wound,and 9 cases(20.9%)underwent functional reconstruction.The follow-up time of 41 patients who survived replantation after surgery was 3 to 42 months,with an average of 17.9 months.According to Chen Zhongwei′s criteria for replantation of severed limbs,5 cases were excellent,24 cases were good,11 cases were fair,and 1 case was poor.Conclusion The replantation of major limbs amputation is relatively complex.It is necessary to ensure the patient′s life safety,eliminate contraindications for replantation,choose safe and fast tissue repair methods,try to shorten limb ischemia time,avoid serious complications after surgery,and undergo sequential rehabilitation treatment to improve limb survival rate and functional recovery after surgery.

关 键 词：四肢 再植术 离断伤 适应证 

分 类 号：R687.3[医药卫生—骨科学]