腕部及前臂远端离断再植术后的远期疗效

Long term Results Following Replantation of Traumatic Amputation at Wrist and Distal Forearm

对６３例腕部及前臂远端离断（完全性３５例，不完全性２８例）再植术后进行了２～２５年（平均８．５年）的随访。结果不全离断再植术后的手关节活动度（ｔｏｔａｌａｃｔｉｖｅｍｏｔｉｏｎ，ＴＡＭ）优良率为６８％，完全离断为３２％。切割伤（３３例）、挤压伤（２０例）及碾挫撕脱伤（１０例）的ＴＡＭ优良率分别为７０％、６０％和２０％；指尖两点辨别觉分别为５．１±０．５ｍｍ、５．７±０．４ｍｍ和７．３±１．４ｍｍ。离断肢体缺血时间７～１０小时、１１～１５小时和１６～２２小时，则再植手的两点辨别觉分别５．１±０．７ｍｍ，６．１±０．５ｍｍ及６．９±１．５ｍｍ，再植后手内在肌挛缩发生率为６５％，手内在肌功能明显减弱或缺失者占９２％。作者强调，尽快恢复离断肢体血循环，清创后离断肢体灌注，完善修复血管（动脉∶静脉＝２∶４）、神经和肌腱，必要的骨短缩术及手筋膜间隔切开术，术后早期功能锻炼和后期的修复重建手术，均是提高再植手功能的重要措施。

Long term results following replantation of 35 complete and 28 incomplete traumatic amputation at the wrist and distal forearm in 63 patients were revieved. The follow up period ranged from 2 to 25 years (mean, 8 year and 6 months). Excellent and good results in terms of total active motion (TAM) were 68% in incomplete and 32% in complete amputations. Excellent and good TAM for various types of wounds were: sharp, 70%(23/33); crush, 60%(12/20); Grind avulsion, 20%(2/10); and the two point discrimination as measurement of finger tip sensation were 5.1±0.5mm, 5.7±0.4mm, and 7.3±1.4mm respectively. Two point discrimination for replanted hands of different duration of ischemia was: 7-10 hours, 5.1±0.7mm; 11-15 hours, 6.1±0.5mm; and 16-22 hours, 6.9±1.5mm. Of these patients, the intrinsic muscle contracture was seen in 65%, and absent or significantly decreased function of intrinsic muscles was encountered in 92%. The authors emphasized the following are stressed as important measures for improving functional results of replanted hand: prompt restoration of blood supply to the severed limb, prereplantation perfusion of the amputated part after debridement, exacting repair of blood vessel(A∶V=2∶4), nerve and tendon, bone shortening as needed, fasciotomies for compartment syndrome of the hand, early functional rehabilitation, and late reconstructive procedures.