缺乏可供吻合静脉的指尖离断再植方法选择

Replantation of fingertip amputation in lack of availability of intravenous anastomosis

目的:探讨缺乏可供吻合静脉的指尖离断再植方法。方法:自2004年11月至2009年11月,对86例104指指尖离断患者进行再植,其中男64例,女22例;年龄2～64岁,平均26岁。伤后至就诊时间30min～12h,断指缺血时间2.5～12h,术前各项检查均未见明显异常。采用4种再植方法:①吻合双侧指固有动脉,指根部结扎一侧指固有动脉的断指再植,37指;②动-静脉转流方式的断指再植,27指;③只吻合指动脉的断指再植,24指;④去表皮囊袋法再植,16指。结果:86例104指,成活102指,伤指成活病例中75例(92指)获得随防,时间6～24个月。按中华医学会手外科学会断指再植术后功能评定试用标准评定:优52例,良19例,差4例。结论:依据显微镜下清创所见离断指尖动脉损伤状况,选用不同的再植方式,有助于扩大指尖再植适应证,提高再植成功率。

Objective ：To discuss the replantation of fingertip amputation in lack of availability of intravenous anastomo- sis. Methods：From November 2009 to November 2010,86 patients （104 fingers） with fingertip amputation were treated with replantatioin, including 64 males and 22 females, with an average age of 26 years ranging from 2 to 64 years. The time from in- jury to therapy was from 30 rain to 12 h ,time of broken finger ischemia was from 2.5 to 12 h. Preoperative examination showed no obvious abnormalities. Four different replantation methods were selectively applied to these 104 amputated fingertips of 86 cases ： （~）replantation with anastomosis of single or bilateral proper digital artery in 37 fingers ; （~）replantation with arteriovenous bypass in 27 fingers ;（3~replantation with exclusive anastomosis of digital artery in 24 fingers; （~）replantation with removing the palmar pocket method in 16 fingers. Results：One hundred and two of 104 amputated fingertips were survived. Among these survived fingers, 75 cases （92 fingers） were followed-up for 6 to 24 months. According to the assessment standard of Chinese Medical Association of Hand Surgery, the results were excellent in 52 cases, good in 19, poor in 4. Conclusion：It benefits to expand the indications and improve the survival rate of replantation of fingertip amputation with the correct choice of different replantation methods according to the injury situation of the broken fingertip artery after debridement under the microscope.