173指手指皮肤套状撕脱伤临床疗效分析

A clinical study of degloving injuries in 173 fingers

目的比较手指皮肤套状撕脱伤三种不同手术方法的疗效，为临床选择合理的治疗方案提供依据。方法对2032年1月至2008年10月期间收治的173指手指皮肤套状撕脱伤患者，分别采用再植术（A组）、第二趾甲皮瓣修复术（B组）和腹部皮瓣修复术（C组），术后对手术方法进行疗效分析。结果术后A组79指中存活72指，成活率为91．1％；B组79指中存活76指，成活率为96．2％；C组15指全部存活。术后随访3个月至2年，平均8个月。按照拇、手指再造功能评定试用标准进行评定：A组中优64指、良6指、可2指，优良率为97．2％；B组中优62指、良10指、可4指，优良率为94．7％；C组中优7指、良6指、可2指，优良率为86．7％。A组与B组的手功能恢复率明显高于c组，A组与B组之间差异无统计学意义。结论治疗手指皮肤套状撕脱伤首选再植术，如远端血管无再植条件可选择第二趾甲皮瓣修复术，如上述2种术式都无条件实施再选用腹部皮瓣修复。

Objective To compare the clinical results of three different treatments for degloving injuries of the fingers. Methods During January 2002 and October 2008, 173 fingers sustained with degloving injuries were treated. The fingers were treated with one of the three different procedures： replantation （group A）, second toe wrap-around flap （group B） and abdominal pediele flap （group C）. The function of the fingers was assessed and the satisfactory rate of three groups was statistically analyzed for all patients. Results Seventy-two of the 79 fingers in group A survived. The overall survival rate was 91. 1%. 76 of the 79 fingers in group B survived, the overall survival rote being 96.2%. All the fingers treated by abdominal pedlele flap survived. Follow-up period ranged from 3 months to 2 years （average 8 months）. According to the evaluation criteria for finger reconstruction issued by the Chinese Hand Surgery Society of Chinese Medical Association, the results were excellent for 64 fingers, good for 6 fingers and fair for 2 fingers in group A, with a satisfactory rate of 97.2 %. In group B 62 fingers were rated as excellent, 10 as good and 4 as fair, with a satisfactory rate of 94.7%. The success rate in group C was 86.7%, with 7 fingers achieving excellent results, 6 fingers good results and 2 fingers fair results. Functional recovery was significantly better in group A and B than in group C, while no difference was found between group A and B. Conclusion Replantafion of fingers with degloving injury is feasible and also can restore the function and shape of the fingers if the degloved skin is still intact.