487例(685指)断指再植体会

Experience of severed finger replantation in 487 cases(685 fingers)

目的探讨断指再植手术的经验与技巧。方法回顾性分析487例(685指)断指再植的临床资料。结果685指成活622指,成活率达90.8%。411例(578指)获得1～5年随访:指间关节僵直21指,屈肌腱粘连17指,行松解术,另有13指肌腱粘连由于不影响功能未行松解术,4指指腹萎缩、感觉差;其余外观、功能和感觉均较理想,拇指关节自主活动度>90°,手指关节自主活动度260°～170°,两点辨别觉为<6mm。按中华医学会手外科学会断指再植功能评定试用标准评定:优393指,良130指,差55指;优良率为90.5%。结论具备丰富的手术经验和技巧才能完成复杂、高难度的再植手术,并适当拓宽断指再植的适应证,获得较高的成功率。

Objective To evaluate the experience and technique on finger replantation. Methods The clinical data of 487 cases （ 685 fingers） of finger replantation were analyzed retrospectively. Results 685 fingers were replanted, of which 622 fingers survived （90. 8% ）. 411 cases （ 578 fingers） were followed up for 1 - 5 years ： interphalangeal joint stiffness occured in 21 fingers;adhesion of flexor tendon was found out in 17 fingers,and releasing was carried out. Another 13 fingers with adhesion of flexor tendon were not operated with releasing because of little influencing on the function; finger pulps atrophied with poor perception was found in 4 fingers;while as to the others, the appearance, function and feelings were ideal. The total range of motion of thumb joints was more than 90° , the total active motion of finger joints was 260° ~ 170° ,and the two point discrimination was less than 6 mm. According to replanted finger function scoring system of Society of Hand Surgery of Chinese Medical Association, the function was excellent in 393 fingers,good in 130,and poor in 55. The excelleat and good rate was 90. 5%. Conclusions Only having affluent experience and technique, can the complex and highly difficult replantation be completed and the indication of replantation be widened to obtain higher achievement ratio.