十指与双前臂同时离断再植成功一例及文献复习

A case of successful replantation of simultaneous amputation of 10 fingers and both forearms and the literature review

目的 探讨十指与双前臂同时离断再植手术方法和术后功能康复。方法2014年9月，应用显微外科技术，对一例十指、双前臂同时离断患者实施断肢、断指再植术。手术分3个再植团队，术中应用顺行再植与逆行再植方法交替，精确的血管、神经吻合，手术历时11h55min，术后2周康复团队介入，物理治疗与作业治疗相结合。结果术后再植肢体、手指全植全活。术后随访14个月，腕关节屈、伸活动功能正常，双手浅、深感觉功能恢复良好，拇、手指握、捏及对掌功能部分恢复，两点辨别觉8～10mm；按中华医学会手外科学会上肢部分功能评定试用标准为良好。结论十指、双前臂同时离断，只要精心组织团队协作、应用娴熟的显微外科技术精细的吻合血管、神经，术后早期功能康复介入，再植肢、指可获得满意的功能恢复。

Objective To investigate the replantation and postoperative rehabilitation methods for simulta- neous amputation of 10 fingers and both forearms. Methods A case of replantation for simultaneous amputation of both forearms and 10 fingers was carried out with microsurgery method in September, 2014. The replantation involved 3 teams over 11 hours and 55 minutes to consequently conduct alternate anterograde and retrograde replantation and accurate blood vessels, nerve anastomosis and further followed with physical therapy and occupational therapy treatment in 2 weeks of the surgery. Results All the amputated arms and fingers revived after the surgery. After 14 months follow-up, function of wrist flexion and expansion was normal, superficial and deep sensory functions on hands were good, function of thumb and finger grip, pinch and opposition had partially recovered, the two-point discrimination was 8-10 mm, and all of above rated good according to the temporary criteria of the upper limb functionality set forth by Hand Surgery Branch of China Medical Association. Conclusion For the case of simultaneous amputation of both forearms and 10 fingers, it is very likely to carry out successful replantation as well as achieve satisfactory function restoration with excellent teamwork and accurate vessel and nerve anastomosis under microsurgery as well as rehabilitation treatment afterwards.