改良内固定针在断指再植中的临床应用研究

Clinical Study of A Modified Internal Fixation Needle in Severe Digital Replantation

目的评价改良内固定针在断指再植中的可行性和临床效果,为断指再植提供一种新的引流静脉瘀血的方法. 方法断指74指,随机分为2组:采用改良12号注射针头、克氏针(外径0.8～1.0 mm)分别用于34指(Ⅰ组)和40指(Ⅱ组)断指再植,术后观察针孔滴血持续时间和出血量,统计各组成活率. 结果术后针孔滴血时间:Ⅰ组平均(127.24±2.41)h,Ⅱ组平均(82.58 ±5.59)h;平均出血量:Ⅰ组(86.25±4.01)ml/d,Ⅱ组(55.36±3.83)ml/d;两组差异显著(P<0.01).术后两组总成活率达90.5%, 其中Ⅰ组达94.1%, Ⅱ组达87.5%, 两组有显著差异 (P<0.05).末节断指再植成活率83.3%, Ⅰ组为87.5%, Ⅱ组为81.3%;非末节断指再植成活率94.0%, 其中Ⅰ组96.2%,Ⅱ组91.7%.术后平均随访1年(6月～2年),手指外形良好,痛温觉恢复,静态两点辨别觉达5～9 mm. 结论应用多孔空心内固定针有更好地引流静脉瘀血作用,可提高断指再植成活率,是一种简便有效的新方法,尤其适用于末节断指再植.

Objective To assess the feasibility and clinical effect of a modified internal fixation needle in severe digital replantation, as a novel way of venous drainage. Methods A modified hypodermic injection needle （F12） （ Group Ⅰ, n = 34） and Kirschner pin （ Group Ⅱ, n = 40） （ outer diameter of 0.8 - 1.0mm） were applied as the internal fixation in 74 cases of severe digital replantation. Duration of bleeding from fixator end, volume of bleeding and survival rate were measured in both groups. Results The duration of bleeding was （ 127.24± 2.41 ） h and （ 82.58 ± 5.59 ） h, the volume of bleeding was （ 86.25 ± 4.01 ） ml/d and （ 55.46 ± 3.83 ） ml/d in Group Ⅰ and Group Ⅱ respectively with significant difference between two groups. The general survival rate was 90.5% , of which 94.1% in group I and 87.5% in group Ⅱ. The survival rate of distal digital replantation was 83.3% , of which 87.5% in group Ⅰ , 81.3% in group Ⅱ. While the rest eases have a survival rate of 94.0% , of which 96.2% in group Ⅰ , 91.7% in group Ⅱ. Nearly normal appearance and recovery of algesia and thermesthesia were observed within 6 months - 2 years follow-up. Conclusion Applying the hollow needle with multiple orifice as the internal fixator can significantly increase the survival rate of severed digital replantation through effective drainage of venous stasis, representing a simple and effective novel method for severed digital replantation, in particular for the distal end.