483例断指再植的临床体会

Clinical effect of 483 cases of finger replantation

目的回顾性分析483例断指再植的临床研究疗效。方法 2007年3月～2010年6月我院采用臂丛麻醉或指根麻醉对483例601指进行断植再植手术,在手术显微镜下彻底清创、精确吻合血管,仔细修复肌腱及指神经。术后常规行"三抗"治疗与早期康复治疗。结果再植601指成活581指,手术成功率为96.7%。术后经6个月～3年3个月的随访,根据断指再植评定标准进行评定,术后功能优良率84.35%。成活指发育良好,长度及外观良好,指骨无吸收,5指有不同程度轻度屈伸功能受限。结论随着显微外科技术的不断发展、再植方法的灵活选择、术后药物的系统应用,显著提高了断指再植的成功率。在手术显微镜下作彻底清创及精良的血管吻合技术是提高末节断指再植成功的关键。

Objective To analyze the clinical efficacy of the 483 cases of finger replantation.Methods Since 2007,finger replantations were performed in 483 patients involving with 603 fingers in our hospital.For finger replantation,debridement,precise vascular anastomosis,careful repair of tendon and nerve were conducted.Patients received antibiotic therapy and took early rehabilitation therapy following operation.Results Among 601 cases of replantation,581 cases survived,with success rate of 96.7%.The length of follow-up ranged from 6 months to 4 years.According to the evaluation criteria of replantation assessment,the excellent and good rate was 98%.The repaired fingers were observed good appearance,and only 5 cases were observed limitation of distal finger extension and flexion,but it didn＇t affect normal function.Conclusion With the development of microsurgical technique,active choice of replantation methods and systemic use of postoperative drugs have significantly improved the success rate.The key points of finger replantation are to conduct thorough debridement and perform good vascular anastomosis under operating microscope.