铡草机绞轧致手部毁损伤显微外科治疗60例  

Microsurgical treatment of severe hand injuries caused by chaff cutters:a report of 60 cases

作　　者：陈禺 董书男 江吉勇 刘承伟 彭龙 关翰辉 CHEN Yu;DONG Shunan;JIANG Jiyong;LIU Chengwei;PENG Long;GUAN Hanhui(Department of Upper Limb Repair and Reconstruction,Beijing Jishuitan Hospital Guizhou Hospital,Guiyang 550014,China;The First Clinical Medical College,Guangxi Medical University,Nanning 530000,China)

机构地区：[1]北京积水潭医院贵州医院上肢修复重建外科,贵阳550014 [2]广西医科大学第一临床医学院,南宁530000 [3]贵州省人民医院骨科,贵阳550002

出　　处：《中华显微外科杂志》2024年第4期438-442,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨铡草机绞轧致手部毁损伤的临床特点与诊治经验。方法回顾性分析2015年1月-2022年6月,北京积水潭医院贵州医院收治的60例(193指)铡草机绞轧致手部毁损伤的病例资料。其中男39例,女21例;年龄10~72岁,平均42.6岁。右手41例,左手19例。毁损部位均为手部从指尖到腕关节间不同程度软组织、骨骼毁损。其中,5指全部毁损8例,包含拇指在内的3个手指毁损12例,包含拇指在内的4个手指毁损10例,不包含拇指的3个及以上手指毁损8例,单纯手掌毁损8例,手指、手掌联合毁损8例,全手毁损6例。创面面积:1.8 cm×2.0 cm~6.8 cm×15.6 cm。入院后根据患者创面污染、组织毁损程度,采用清创、残端修整、原位再植、移位再植、静脉皮瓣桥接移植以及急诊或二期行游离第2足趾、游离皮瓣移植等方法修复。皮瓣切取面积:3.0 cm×5.0 cm~7.0 cm×16.0 cm。再造及皮瓣供区均一期直接闭合。出院后定期门诊或微信随访,观察皮瓣、手指的成活和功能恢复情况。结果本组60例,急诊行原位再植112指,成活96指;移位再植16指,成活12指;静脉皮瓣桥接移植5指,成活4指;Flow-through股前外侧穿支皮瓣(ALTPF)5例,成活5例;急诊及二期行游离第2足趾移植再造12指,均成活;二期行游离皮瓣移植18例[其中ALTPF 10例,旋髂浅动脉穿支皮瓣(SCIAPF)8例]均成活。术后出现伤口渗出、发热等感染征象者8例,予清创、抗感染对症处理后均控制。术后随访6~18个月,平均12个月,随访截止时间:2024年1月。手功能按密歇根大学手概况问卷调查表(MHQ)得分20.3~72.8分,平均(42.6±16.6)分。结论铡草机绞轧所致手部毁损伤伤情复杂,需充分评估创面污染程度、残余手指及组织,经急诊和择期采用多种显微外科技术、多次手术修复重建,可取得相对满意的疗效,但此类损伤最终手部整体功能恢复不理想。ObjectiveTo explore the clinical characteristics and experiences in diagnosis and treatment of severe hand injuries caused by chaff cutters.MethodsA retrospective analysis was conducted on 60 patients(193 digits)who had mangled hand injuries caused by chaff cutters and admitted to the Department of Upper Limb Repair and Reconstruction,Beijing Jishuitan Hospital Guizhou Hospital between January 2015 and June 2022.The patients were 39 males and 21 females,with 10 to 72(mean 42.6)years old of age.The injuries involved 41 right hands and 19 left hands.The extent of hand injuries of soft tissue and bones varied from digit-tips to wrist.Among them,5 digits were completely destroyed in 8 cases,3 digits including thumb were destroyed in 12 cases,4 digits including thumb were destroyed in 10 cases,3 or more fingers without thumb were destroyed in 8 cases,simple hand destroyed in 8 cases,digits and palm destroyed in 8 cases,and total hand destroyed in 6 cases.The sizes of wound ranged from 1.8 cm×2.0 cm to 6.8 cm×15.6 cm.Based on the wound contamination and conditions of tissue damage,surgical treatment included debridement,stump trimming,in-situ replantation,transpositional replantation,venous bridging flap transfer and emergency or phased free second toe and free flap transfers.The flap sizes were 3.0 cm×5.0 cm-7.0 cm×16.0 cm.Both the reconstructed and flap donor sites were primarily closed in one stage.Postoperative follow-ups were conducted through regular visits of outpatient clinic or via WeChat interviews.The survival and functional recovery of flap and finger were observed.ResultsOf the 60 patients,emergency orthotopic replantation of 112 digits were performed with survival of 96 digits;16 digits transposition replantation were carried out with 12 survived;5 digits received venous bridging flap transfer with 4 survived;all 5 Flow-through anteriolateral thigh perforator flaps(ALTPFs)were survived;all of 12 phase II digit reconstructions with free second toe transfer survived;and all 18 phase II free flap transfe

关 键 词：手指再造 毁损伤 铡草机 显微外科技术 

分 类 号：R658.2[医药卫生—外科学]