不同血液循环通路下末节断指再植手术效果比较  

Comparison of surgical effect of various circulatory pathways on replantation of severed distal segment of digits

作　　者：任磊 扈克治 吕波 闫泽正 康艳兵 张世超 谢中来 唐明 陈惠 REN Lei;HU Kezhi;LYU Bo;YAN Zezheng;KANG Yanbing;ZHANG Shichao;XIE Zhonglai;TANG Ming;CHEN Hui(Department of Trauma Orthopaedics and Microsurgery,Guilin People’s Hospital,Guilin 541002,China)

机构地区：[1]桂林市人民医院创伤骨科与显微外科,桂林541002

出　　处：《中华显微外科杂志》2024年第4期430-437,共8页Chinese Journal of Microsurgery

摘　　要：目的探讨不同血液循环通路下末节断指再植手术效果的差异。方法回顾性分析2017年6月至2023年6月桂林市人民医院创伤骨科与显微外科收治并进行手术的末节手指离断伤患者共137例162指,其中男82例97指,女55例65指,年龄11个月~51岁,平均31.7岁。受伤指别:拇指36指,示指43指,中指32指,环指28指,小指23指。受伤原因:电锯伤55指,利刃伤68指,绞伤26指,脱套伤13指。按照不同的血液循环建立方式分为生理再植组(PRG)66例88指、动脉静脉化组(AVG)50例53指和甲床放血组(NBG)21例21指,术后进行门诊随访或者家庭随访,记录术后并发症发生率,并按照中华医学会手外科学会断指再植功能评定试用标准评定患指功能恢复情况。采用方差分析或者卡方检验来分析各组患者年龄、性别、受伤至手术时间、手术时长、再植手指血管危象发生率、成活率、患指功能恢复评分以及术后并发症发生率,P<0.05为差异有统计学意义。结果患者术后门诊或家庭随访6.0~10.0(平均7.2)个月。患指功能恢复评分方面,按照中华医学会手外科学会断指再植功能评定试用标准,PRG[(86.3±7.9)分]优于NBG[(78.3±11.2)分]及AVG[(70.7±8.6)分],差异均有统计学意义(P<0.05);血管危象发生率方面,PRG(3指,发生率3.4%)优于NBG(1指,发生率4.8%)及AVG(6指,发生率11.3%),差异均有统计学意义(P<0.05);在成活率方面,PRG(成活81指,成活率92.0%)优于NBG(成活18指,成活率85.7%)及AVG(成活42指,成活率79.2%),差异均有统计学意义(P<0.05);术后并发症发生率方面,PRG(12.6%)优于AVG(17.1%)及NBG(21.2%),差异均有统计学意义(P<0.05)。结论对于末节手指离断伤,优先选择生理性再植,对于无法探及回流静脉患者,可通过动脉静脉化或者甲床放血获得有效再植。ObjectiveTo investigate the surgical effect of various circulatory pathways on replantation of severed distal segments of digits.MethodsFrom June 2017 to June 2023,a total of 137 patients(162 digits)who received digit replantation surgery in the Department of Trauma Orthopaedics and Microsurgery of Guilin People's Hospital were retrospectively studied.The patients were 82 males(97 digits)and 55 females(65 digits)aged 11.0 months to 51.0 years old,with 31.7 years old in average.The injured digits were 36 thumbs,43 index fingers,32 middle fingers,28 ring fingers and 23 little fingers.Causes of injury:55 digits were of electric saw,68 of sharp object cut,26 of twisting crush and 13 of degloving injury.According to the circulatory pathways,66 patients(88 digits)were assigned to a physiological replantation group(PRG),50 patients(53 digits)to an arterio-venolisation group(AVG)and 21 patients(21 digits)to a nail bed bloodletting group(NBG).Functional recovery was evaluated according to the Evaluation Standard of Severed Finger Functional of Hand Surgery of Chinese Medical Association.Analysis of variance or chi-square test was employed to analyse the age,gender,time from injury to surgery,surgery time,incidence of vascular compromise of the replanted digit,survival rate,score of functional recovery of the affected digit at 6 months after surgery,and incidence of postoperative complications in each group.P<0.05 was considered statistically significant.ResultsAll patients were included in the 6-10 months of postoperative follow-up,with an average of 7.2 months.Regarding the score of functional recovery of affected digit according to the Evaluation Standard of Severed Finger Functional of Hand Surgery of Chinese Medical Association,PRG(86.3 points±7.9 points)was higher than that of NBG(78.3 points±11.2 points)and AVG(70.7 points±8.6 points),with statistically significant differences(P<0.05 for both).In terms of the incidence of vascular compromise,PRG(3 digits for 3.4%)was lower than that of NBG(1 digit for 4.8%)and AV

关 键 词：断指再植 手指末节 血液循环通路 生理性再植 动脉静脉化 甲床放血 

分 类 号：R658.1[医药卫生—外科学]