逆行法断拇趾再植

Retrograde replantation method for amputated hallux

目的 探讨逆行法拇趾再植的特点及其效果。方法 对 18例离断拇趾进行再植 ,再植时保持患足背伸 90°～ 12 0°。逆行法再植的顺序 :趾底皮肤→趾底皮下静脉→趾固有神经→趾固有动脉→屈趾肌腱→单根克氏针固定趾骨→伸趾肌腱→趾背动脉→趾背皮下静脉→两侧及背侧皮肤。结果 16例成活 ,成活率 88.9% ,患拇总屈曲度为 2 5°～ 70°,断拇外形恢复良好 ,趾尖两点辨别力 10～ 16 mm,患者行走步态正常 11例 ,基本正常 7例。结论 断拇离断再植极大减轻病人伤残 ,功能及外观恢复满意 。

Objective To investigate the characteristics and the effect of severed hallux replantation.Methods Eighteen completely severed halluces had been replanted since 1991.Injuried foot were kept in extending at 90°-120° position.The sequence of hallux replantation was opposed to the classical order and was so called'the retrograde replantating means(RRM)'.The order of RRM was defined as follows: skin of toe abdomen→subcutaneous vein of toe abdomen→inhered toe nerve→inhered toe artery→flexor toe tendon→toe fixation by a single K-needle→extendor toe tendon→artery in the back of toe→subcutaneous vein of toe back→skin of bilateral and back.Results Sixteen of eighteen halluces survived replantation(89.9%).The total flexion degree in replanted halluces was 25°～70°.The appearance of amputated toes restored well.The two-point discrimination was 10～16 mm.Eleven cases walked as entirely usually in gait, and seven cases had basic normal gait.Conclusions Replantation of severed halluces could alleviate wound and remnant greatly.The recovery of foot function and aspect of replanted toes was satisfactory.The RRM gradation showed a distinctive advantage that there was no requiring for injuried foot be moved during operation.