部分趾骨的游离甲瓣移植治疗拇指脱套伤后患者拇指功能恢复情况分析

Analysis of Thumb Functional Recovery of Patients with Thumb Degloving Injury After Free Nail Flap Transplantation of Part Phalange

目的分析部分趾骨的游离甲瓣移植治疗拇指脱套伤后患者拇指功能恢复情况。方法随机抽取2011年2月至2014年2月期间我院收治的拇指脱套伤患者105例作为研究对象。按手术方式的不同分为对照组（n=52）和观察组（n=53），对照组行创面同侧和对侧踌趾腓侧皮瓣联合跖背动脉逆行岛状皮瓣治疗，观察组行部分趾骨的游离甲瓣移植拇指再造术治疗。术后随访6～12个月。观察对比两组患者的皮瓣成活率、两点分辨觉及再造拇指功能恢复情况。结果观察组优良率、皮瓣成活率为96．23％、100．00％，显著高于对照组的78．85％、76．92％（均P〈0．05）。两组患者的一期、二期创面愈合率比较差异无统计学意义（P〉0．05）。观察组两点辨别距离显著短于对照组（P〈0．05）。结论对拇指脱套伤后患者采取部分趾骨游离甲瓣移植再造术治疗可促进再造拇指功能的恢复．且拇指缺损成瓣成活率高．术后两点分辨觉高．值得临床推广应用。

Objective To explore the functional recovery of thumb of patients with thumb degloving injury after free nail flap transplantation of part phalange. Methods A total of 105 patients with thumb degloving injury admitted to our hospital from February 2011 to February 2014 were selected and divided into two groups. 52 cases of control group received the treatment of fibular flap combined with torsal metatarsal artery island flap, while 53 cases of observation group received thumb reconstruction with free nail flap transplantation of part phalange. All patients were followed up for 6 ~ 12 months, and the flap survival rate, two-point-discrimination, and functional recovery of reengineering thumb were observed and compared between two groups. Results The excellence and good rate and flap survival rate of observation group were 96.23% and 100.00% respectively, significantly higher than 78.85% and 76.92% of control group, respectively（both P〉0.05）. The one-stage and tw-stage wound healing rates had no statistical difference between two groups（P〈0.05）. The two-pointdiscrimination of observation group was significantly shorter than that of control group（P〈0.05）. Conclusions Free nail flap transplantation of part phalange for the treatment of patients with thumb degloving injury can promote the recovery of thumb function, and has high flap survival rate and shorter postoperative two-point-discrimination, which is worthy of clinical application.