30例手指皮肤套脱伤再植术后疗效及评价

Replantation of thumb or f＇mgers with skin degloving injury in 30 patients： an outcomes evaluation

目的报告应用再植术治疗手指皮肤套脱伤术后的疗效。方法对我院自2007年至2012年30例共42指采用再植术治疗手指皮肤套脱伤的病例进行2～7年（平均4年）的随访观察，并将示指、中指、环指、小指套脱伤按撕脱平面分为Ⅰ度套脱伤和Ⅱ度套脱伤，应用中华医学会手外科学会断指再植功能评定试用标准及MHQ手功能评价标准对手指功能进行评定。结果根据中华医学会手外科学会断指再植功能评定试用标准评定，30例手指皮肤套脱伤患者术后恢复优良率达93．3％，其中Ⅰ度皮肤套脱伤术后恢复优良率达100％，Ⅱ度皮肤套脱伤术后恢复优良率87．5％。根据MHQ手功能评价标准，患者主观评价得分较高。结论运用再植术治疗手指皮肤套脱伤，修复的手指可最大限度地恢复外形和功能，其中Ⅰ度套脱伤术后恢复效果高于Ⅱ度套脱伤术。患者对术后恢复的满意程度较高。

Objective To report the clinical outcomes of replantation of thumb and fingers with skin degloving injuries. Methods Thirty patients with 42 avulsed thumb and fingers treated with replantation from 2007 to 2012 were follow-up for 2 to 7 years （average, 4 years）. Based on the level of the degloving injury, avulsion of the index, middle, ring and little fingers was categorized into grade Ⅰ avulsion and grade Ⅱ avulsion. The results of replantation were assessed by the provisional functional assessment criteria for thumb and finger replantation issued by the Hand Surgery Society of Chinese Medical Association and by the Michigan hand outcomes questionnaire （MHQ）. Results According to the provisional functional assessment criteria for thumb and finger replantation issued by the Hand Surgery Society of Chinese Medical Association, 93.3% of the cases achieved excellent and good results. This satisfactory rate was 100% in grade Ⅰ avulsions and 87.5% in grade Ⅱ avulsions. MHQ revealed high patient satisfaction. Conclusion Replantation of thumb and fingers with skin degloving injuries can lead to fairly high patient satisfaction with restoration of form and function. Grade Ⅰ avulsions have better results than grade Ⅱ avulsions.