末节旋转撕脱性断指再植88 例疗效分析.DOCVIP

临床医学论文-末节旋转撕脱性断指再植88 例疗效分析 ?摘要：目的? 探讨88 例108指末节旋转撕脱性断指的再植方法和临床效果。方法? 根据末节断指的三种分型和不同的损伤情况采取不同的再植方法，随访成活率和术后功能。结果? Ⅰ型共82指，77指成活，成活率93.90％；Ⅱ型共20指，17指成活，成活率85.00％；Ⅲ型共6指，2指成活，成活率33.33％。其中成活的90指指体经过0.5～2年的随访，外观功能恢复良好，感觉基本恢复正常。结论? 对于Ⅰ～Ⅱ型末节旋转撕脱性断指，采取高超的显微外科技术进行再植，仍可以取得很高的成活率，且外观功能恢复佳，可以尽最大可能再植。 ??? 关键词：再植术；旋转撕脱性断指；显微外科 ??? The Replantation Effects of Rotated Avulsion Amputated Distal Part of Fingers ?????? Abstract： Objective? Investigate replant methods and clinical effects of 108 rotated avulsion distal part of fingers which involved in 88 cases. Methods? Different methods were applied to amputated distal part of fingers according to classification， and the living rate and postoperative function were followed. Results? There were 77 replanted fingers alive in type Ⅰ， and the living rate was 93.9％. There were 17 alive in type Ⅱ， and the living rate was 85％. There were 2 alive in type Ⅲ， and the living rate was 33.33％. The appearance and function of all 90 living replanted fingers were excellent and good after followed up by 0.5～2years， and the sensation of distal part of replanted fingers were near to be normal. Conclusion? High living rate could be obtained if excellent microsurgery technique was applied to replant rotated avulsion distal part of fingers of type Ⅰ and Ⅱ， and the appearance and function of replanted fingers would be excellent and good. ??? Key words： replantation； rotated avulsion amputated fingers； microsurgery ??? 随着显微技术的进步和发展，断指的再植成功率虽然有了很大的提高，但末节旋转撕脱性断指再植仍很棘手。我院自2000年1月至2004年12月，对88 例108指末节撕脱性断指进行了再植，取得了一定的效果，现报道如下。 ??? 1? 临床资料 ??? 1.1? 一般资料? 本组88 例，男68 例，女20 例，平均年龄22.5 岁(16～45 岁)。皮带卷伤45 例54指，纺织机卷扎伤20 例28指，滚轴卷伤12 例14指，其他11 例12指。其中拇指48指，食指22指，中指18指，环指12指，小指8指。按章伟文的末节断指分型［1］，Ⅰ型断指68 例82指，Ⅱ型断指16 例20指，Ⅲ型断指4 例6指。 ??? 1.2? 手术方法? 在臂丛麻醉下用气压止血带止血，充分暴露创面，适当缩短指骨，显微镜下彻底清创，分别找出近远端指动脉神经，并做好标记，根据撕脱的动脉及离断的平面来进行再植。 ??? 1.2.1? Ⅰ型离断? 对于动脉撕脱在1 cm以内的，有35 例42指，35指经缩短近端指骨融合远侧指间关节后克氏针固定，7指保留远侧指间关节克氏针固定，用110尼龙线吻合双侧指动脉，吻合指背2～3支静脉。对于动脉撕脱在1 cm以上的，有33 例40指，均保留远侧指间关节，克氏针固定骨折，取前臂浅静脉移