影响断指再植成活的因素（附288指分析）

FACTORS INFLUENCING SURVIVAL OF DIGITAL REPLANTATION

总结断指再植１９０例２８８指，总成活率８１．１％。与成活率有关的因素是：①断指再植的坏死率与缺血时间呈正相关（ｒ＝０．７６５９，Ｐ＜０．０１），温缺血时间达１６小时以后，再植成活率明显下降。认为断指再植的最佳缺血时间为１２小时以内，再植时限（温缺血）应为２２小时。②不同损伤性质对再植成活率有明显影响，成活率高低排列依次为：切割伤、电锯伤、压砸伤、撕脱伤（ｘ２＝１１．３４，Ｐ＜０．０１）。③端端法和套入法吻合血管不影响再植成活率（Ｐ＞０．０５），但套入法单指再植时间较端端法节省约４０分钟，（ｑ＝３．１４８０，Ｐ＜０．０５）。④手术探查的危象挽救率明显高于保守治疗（ｘ２＝２０．１７，Ｐ＜０．００１），提出及时发现并不失时机的手术探查是血管危象最佳补救方法。

he results of replantation of 288 severed fingers in l90 cases are summarized.The total sur-vival rate(SR)was 81.1%. The factors related to the SR of replantation are discussed as follows:(l)The necrotic rate of digital replantation is positive correlation with the ischemic time(r=0.7659,P<0. 01).The SR of replantation greatly descends after 16 hours of warm ischemic time.It is thought that the reasonable ischemic time of replanation is within l2 hours and that the re-plantation time limit(warm ischemic time)should be 22 hours.(2) The different character of in-juries has a great influence on the SR of replantation. The order of survival from high to low should be as followed: cutting wound, electrosaw injury, crush injury, avulsed wound(x2=11. 34,P<0.01).(3)The SR between end一to一end anastomosis and sleeve anastomosis shows no significant difference(P>0.05),but the replantating duration for each finger with sleeve anasto- mosis is faster than that with end一to一end anastomosis for 40 minutes(q=3. 1480, P< 0. 05 )。(4)The save rate of vascular crises by exploratory operation is inuch higher than that by con-servative treatment(X2=20. 17, P<0. 001)。It ls.proposed that timely discovery and exploraty operation be the best way for the treatment of vascular crises.