大肢体离断再植术中预防性筋膜切开减压应用效果  

The application effect of preventive fasciotomy decompression in the replantation of severed limbs

作　　者：滕志成 王凯 巨积辉[1,2] 刘跃飞 金光哲[1,2] 董帅 柳志锦[1] 吕永江 Teng Zhicheng;Wang Kai;Ju Jihui;Liu Yuefei;Jin Guangzhe;Dong Shuai;Liu Zhijin;Lv Yongjiang(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》2024年第1期78-83,共6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：目的探讨预防性筋膜切开减压在大肢体离断再植中的应用效果。方法自2012年12月至2022年12月对53例大肢体离断患者行再植治疗。收集患者临床资料包括年龄、缺血时间、休克程度、离断平面、骨骼软组织损伤情况,评估毁损肢体严重程度评分(mangled extremity security score,MESS)。根据离断平面和MESS评分分为4组,即A组11例(低位离断-MESS<9组)、B组16例(低位离断-MESS≥9组)、C组15例(高位离断-MESS<9组)、D组11例(高位离断-MESS≥9组)。采用独立样本t检验分析4组中再植术中实施预防性筋膜切开减压对术后乳酸(LA)及肌酸激酶(CK)的影响。术后观察再植肢体存活情况,随访再植肢体功能恢复情况。结果再植术中预防性筋膜切开减压27例,未预防性筋膜切开减压26例。再植术中预防性筋膜切开减压能够降低术毕时血中LA。再植术中预防性筋膜切开减压并不能降低A组术后短期内血中CK,差异无统计学意义(P>0.05);能够降低B组、C组和D组术后第三天血中CK,同时降低D组患者术后第二天血中CK,差异有统计学意义(P<0.05)。再植术后肢体坏死2例,51例再植存活患者术后随访4~42个月,平均16.4个月。根据陈中伟断肢再植评定标准:优7例,良27例,可14例,差3例。结论对于高位离断患者,再植术中预防性筋膜切开减压能够在一定程度上降低术后肌肉软组织坏死程度。对于低位离断患者,若MESS≥9,再植术中预防性筋膜切开减压效果较好;若MESS<9,术中可不用实施预防性筋膜切开,术后严密观察,最大程度避免过度切开可能带来的并发症。Objective To explore the application effect of preventive fasciotomy decompression in replantation of severed large limbs.Methods From December 2012 to December 2022,53 patients with large limb amputation were treated with replantation.The clinical data of patients were collected,including age,ischemic time,degree of shock,fracture plane,and skeletal and soft tissue damage.The mangled extremity security score(MESS)was evaluated.According to the dissociation plane and MESS score,they were divided into 4 groups,namely Group A with 11 cases(low dissociation,MESS<9 group),Group B with 16 cases(low dissociation,MESS≥9 group),Group C with 15 cases(high dissociation,MESS<9 group),and Group D with 11 cases(high dissociation,MESS≥9 group).The independent sample t-test was used to analyze the effects of preventive fasciotomy decompression during replantation surgery on postoperative lactate(LA)and creatine kinase(CK)in four groups.The survival of the replanted limb was observed after surgery and the functional recovery of the replanted limb were followed up.Results During the replantation surgery,27 cases underwent prophylactic fasciotomy for decompression,while 26 cases did not undergo prophylactic fasciotomy for decompression.The preventive fasciotomy and decompression during replantation could reduce LA in the blood at the end of the surgery,but could not reduce the short-term blood CK in Group A,and the difference was not statistically significant(P>0.05).It could reduce the blood CK levels in Group B,C and D on the third day after surgery,while also reduce the blood CK levels in Group D patients on the second day after surgery,with a statistically significant difference(P<0.05).There were 2 cases of limb necrosis after replantation.51 patients who survived replantation were follow-up for 4 to 42 months postoperatively,with an average of 16.4 months.According to Chen Zhongwei′s criteria for limb replantation,there were 7 excellent cases,27 good cases,14 fair cases,and 3 poor cases.Conclusion For patients with hig

关 键 词：再植术 治疗结果 肢体 离断伤 筋膜切开 

分 类 号：R658.1[医药卫生—外科学]