伴有严重复合创伤的上肢离断再植

Replantation of severed upper limb with severe compound injuries

目的探讨伴有严重复合创伤的上肢离断再植的可能性。方法纠正休克和恢复水电解质平衡后，行左上臂离断再植合并脾摘除术1例；前臂离断再植合并多发骨折固定。神经肌肉组织断裂修复4例；左前臂离断再植合并多发骨折固定，尿道断裂尿道会师术1例；右前臂离断再植合并多发骨折固定，大面积皮肤缺损修复1例。结果休克得到纠正，合并伤获得有效控制及愈合，断肢离断再植均成活。随访半年以上的6例中，2例上臂离断再植后恢复伸屈肘功能，感觉恢复至肘下10cm和14cm，手内在肌萎缩。4例前臂离断再植后肢体恢复尺神经支配感觉区域，正中神经恢复保护性感觉，其中有2例手内在肌萎缩，手指活动屈伸活动范围28°～50°。能完成握持物体的一般性生活功能。结论伴有严重复合创伤经有效的治疗后试行上肢离断再植术是可行的。

Objective To investigate the feasibility of upper limb replantation with severe compound injuries. Methods After shock was corrected and fluid and electrolyte balance was achieved, replantation of severed upper limb was attempted in patients with compound injuries. One patient had replntation of the left upper arm and splenectomy. Four patients underwent replantation of the fore.ann and fixation of multiple fractures and repair of nerves and muscles. One patient had replantation of the left forearm, multiple fracture fixation and urethral realignment of ruptured urethra. Another patient underwent replantation of the right forearm, multiple fracture fixation and repairing of large soft tissue defect. Results Shock was corrected and accompanying injuries were effectively treated and healed. All of the 7 replanted limbs survived. Six cases were followed-up for more than 6 months. Extension and flexion of the elbow joint was restored and sensation recovered to 10 and 14 cm below the elbow in 2 cases with upper arm severance and replantation. The hand intrinsic muscles were atrophied. In 4 cases with forearm severance and replantation protective feeling was recovered in the median nerve and ulnar nerve territory. Hand intrinsic muscle atrophy was noted in 2 cases. Total active range of motion of the fingers was 28° to 50°. The patients could use the affected hand to grip objects in activities of daily living. Conclusion It is feasible to replant severed upper limb in patients with compound injuries after effective control of co-morbidities.