复杂断肢再植临床分析(附5例报告)

Clinical Analysis of Severed Limb Replantation (5 Cases Report)

目的探讨断肢再植术的处理方法,提高断肢再植成活率及患肢功能。方法5例断肢患者,包括断上臂中段、腕、大腿中下段、小腿中上段及断掌并多个断指各1例,断端污染严重,均予再植。离断至吻合时间约4～7 h。所有病例均以8-0显微丝线吻合主要动静脉及神经。结果随访12～36月,断掌功能良好;再植上臂、大腿均成活;断上臂术后8月,肘关节活动范围约5°,其他关节无功能,感觉无恢复;断大腿者能行走,小腿中段以上感觉恢复;腕、小腿再植者失活。结论复杂断肢再植应妥善行术前处理,彻底清创,行断肢再灌注和血管吻合,重视围术期处理和功能重建,以提高断肢再植成活率和功能恢复。

Objective To explore the perioperative management of replantation of isolated severed limbs,to enhance the survival rate and function of replanted limbs.Methods 5 cases were underwent replantation of isolated severed limbs,including upper arm,wrist,palm with several fingers,thigh and leg,and 1 case for each.All the isolated limbs were serious trauma.The interval between injury and operation was 4 to 7 hours.The main arteries,veins and nerves were anastomosis by 8-0 micro silk threads.Results All patients were followed up from 12 to 36 months.Good function was restored in the case replanted palm.The replanted-upper arm and the thigh were survived,and the wrist and the leg were not.The elbow joint motion was limited in 5°.And the function and feeling was not recovery in the case of upper arm replanted.Walking and feeling of upper leg was restored in the case of thigh replanted.Conclusion It is important of appropriate preoperative management,thoroughly debridement,and effective severed reperfusion and vascular anastomosis for isolated severed limb replantation,and perioperative management and function reconstruction must be attention to increase the survival rate and functional restoration of replanted limb.