断指再植1000例1432指临床回顾与分析

Clinical review and analysis on replantation of severed fingers in 1000 cases(1 432 fingers)

目的总结分析断指再植的技术问题及临床经验。方法对1 000例1 432个断指行再植术,按常规清创、骨骼固定、修复肌腱、吻合血管、吻合神经,血管、肌腱移位,指掌侧动脉蒂岛状皮瓣转位,以及邻指背侧静脉蒂岛状皮瓣转位等方法,重建断指血运并修复肌腱,术后2周开始功能锻炼,4周拔克氏针,加强关节功能锻炼。结果成活1 315指,坏死117指,成活率为91.83%。成活指中,按功能评定标准评定,优941指,良244指,可86指,差44指,总优良率达到90.11%。结论彻底清创是断指再植手术成功的基本前提,对血管精细吻合是成功的关键,一期修复神经并及时功能锻炼是手指功能恢复的重要方法。

Objective To summarize and analyze the technical problems and clinical experiences in severed finger replantation.Methods Totally 1 432 severed fingers in 1 000 cases were replanted.Severed blood supply was reconstructed and tendons were repaired by using the methods of debridement,fixing bone,repairing tendon,vascular anastomosis,nerve anastomosis,blood vessels and tendons shift,palmar finger artery island flap transposition and adjacent dorsal vein island flap transposition etc.Function practice was started two weeks after operation and Kirschner wire was pulling out at 4th week postoperatively to strengthen the joint function exercises.Results There were 1 315 survived fingers and 117 necrotic fingers,the survival rate reaching 91.83%.In all survived fingers,941 fingers were excellent,244 fingers were good,86 finger were fair and 44 fingers were poor according to function evaluation standard,the total excellence and good rate amounting to 90.11%.Conclusion Thorough debridement is the basic premise of successful replantation,fine vascular anastomosis is the key to success and first phase nerve repair and timely functional exercise are the important method for finger functional recovery.