Tamai I~II区指尖离断再植改良方法及临床疗效  

A modified procedure for replantation of severed digit-tips in Tamai zones I-II and the clinical effects

作　　者：刘洋洋 吴敏[1] 朱军 高许斌[1] 张宽宽 韩仲兵 牛海州 LIU Yangyang;WU Min;ZHU Jun;GAO Xubin;ZHANG Kuankuan;HAN Zhongbing;NIU Haizhou(Department of Hand and Foot Microsurgery,the First Afiliated Hospital of Bengbu Medical College,Anhui Key Laboratory of Tissue Transplantation,Anhui Bone and Joint Diagnosis and Treatment Centre,Bengbu,Anhui Province 233004,China)

机构地区：[1]蚌埠医学院第一附属医院手足外科,组织移植安徽省重点实验室,安徽省骨与关节诊疗中心,安徽文蚌埠233004

出　　处：《中华显微外科杂志》2024年第1期78-83,共6页Chinese Journal of Microsurgery

基　　金：蚌埠医学院自然科学重点项目(2020byzd175)。

摘　　要：目的:探讨Tamai I~II区指尖离断再植的改良方法及临床疗效。方法:自2019年11月至2022年10月,蚌埠医学院第一附属医院手足显微外科采用改良方法(放弃先解剖标记血管、神经,肉眼清创、骨折固定后,显微镜下一次性游离和修复血管、神经;甲侧襞辅助小切口探查吻合修复背侧静脉)对26例(29指)Tamai I~II区指尖离断再植。本组患者男20例(23指),女6例(6指);年龄3~66岁,平均28岁。Tamai I区16例(19指),Tamai II区10例(10指),伤指指别:拇指7指,示指9指,中指5指,环指5指,小指3指。致伤原因:切割伤12例,挤压伤8例,撕脱伤6例。术后预防感染、解痉3 d,卧床休息5 d,统计患者手术时间;术后门诊随访患者6~12个月,包括成活率及外观、感觉恢复、运动和手指力量及患者满意度情况。结果:①手术时间:Tamai I区指尖离断再植时间约1.0 h;Tamai II区指尖离断再植时间约1.5 h。②成活率及外观:26例指尖离断再植全部成活(2例Tamai I区患指术后第2天静脉危象,小切口放血3 d后成活),22例患者指腹脂肪垫恢复,指腹较饱满,4例撕脱指尖离断,指腹轻度萎缩。Tamai I区15例患者指甲无畸形,较健侧短约2 mm;1例患者因术前甲床真菌感染,术后指甲外观不佳。③感觉恢复:采用英国医学研究会(BMRC)手指感觉评定标准,23例感觉恢复S 3+;2例指尖撕脱指尖离断和1例挤压指尖离断患者感觉恢复S 3。指尖离断患者指端TPD:切割伤患者4~7 mm;挤压伤患者6~8 mm;撕脱伤患者9~11 mm。④运动和手指力量:按我国手外科学会推行总主动活动度标准进行功能评定:优21例,良5例,手指捏持、握拿时指腹无疼痛。Tamai I区指尖离断患者手指活动度与健侧接近;5例Tamai II区指尖离断,因经远侧指骨间关节处离断,主动伸直0°、屈曲2°~3°。⑤患者满意度调查:满意25例,1例Tamai II区拇指指尖离断患者对指骨间关节活动度不满意。 结论:Tamai I~II区指尖离断采�Objective To explore the clinical effect of a modified surgical procedure for replantation of severed digit-tips in Tamai zones I-II.Methods From November 2019 to October 2022,the Department of Hand and Foot Microsurgery of the First Affiliated Hospital of Bengbu Medical College employed a modified procedure(to abandon the anatomically labelling of blood vessels and nerves after naked-eye debridement and fracture fixation,then perform the microscopic dissections and anastomoses of blood vessels and nerves,and the anastomosis of dorsal veins though an auxiliary small incision by the lateral nail fold of the severed digit-tip)to replant severed digit-tips in Tamai zones I-II of 26 patients(29 digits).The patients were 20 males(23 digits)and 6 females(6 digits),aged 3-66 years old,with mean age at 28 years old.Nineteen digit-tips were severed in Tamai zone I and 10 in Tamai zone II.The severed digit-tips were 7 of thumbs,9 of index fingers,5 of middle fingers,5 of ring fingers and 3 of little fingers.Causes of injury were 12 of cut,8 of crush and 6 of avulsion.Postoperative management included infection prevention,antispasmodic for 3 days and keeping in bed for 5 days.The time of surgery was recorded on all patients.Postoperative follow-ups were conducted at outpatient clinics for 6 to 12 months to observe the survival of digit-tips and the appearance,recovery of sensation and motor functions,strength of digits and patient satisfaction.Results (1)The surgical time was about 1.0 hour for replantation of a severed digit-tip in Tamai zone I,while it took about 1.5 hours for those in Tamai zone II.(2)Survival rate and appearance:all 29 replanted digit-tips survived,except 2 in Tamai zone I which encountered venous occlusion and survived after small incision for bloodletting.Twenty-two digit-tips gained pulp fat pads with full digit pulps.Four avulsed digit-tips had mild atrophy of pulp.The 15 digit-tips severed in Tamai zone I were about 2 mm shorter than the healthy sides,but without deformity.One digit-tip had poor na

关 键 词：断指再植 指尖离断 Tamai分区 显微外科技术 

分 类 号：R658.1[医药卫生—外科学]