断指再植治疗手指末节完全离断伤的临床效果及影响断指再植成活率的因素分析

Clinical efficacy of finger replantation in the treatment of complete distal segment finger amputations and the analysis of the factors affecting the survival rate of patients with replantation of severed finger

目的观察断指再植与非断指再植在治疗手指末节完全离断伤的临床效果，分析影响断指再植患者成活率的相关因素。方法选取2015年3月至2016年6月我院收治的62例手指末节完全离断伤患者，随机分为观察组和对照组，每组31例。观察组行断指再植术治疗，对照组行非断指再植术（皮瓣修复、原位缝合及残端修整）治疗。对比两组患者早期指体成活率，再植指指甲生长情况、两点辨别觉、远端指间关节活动度及手指关节活动度。同时对我院近5年来收治的288例单指断裂行再植术患者的临床资料进行回顾性分析，根据术后断指成活情况分为成活组214例，未成活组74例，单因素分析采用描述性方法，多因素分析采用Logistic回归方程，分析影响断指再植成活率的相关因素。结果观察组早期指体成活率为8.57%（3/35），对照组早期指体成活率为15.15%（5/33），两者比较差异无统计学意义（χ^2＝0.216，P〉0.05）；术后6个月，观察组再植指指甲生长长度[（13.5±2.9） mm]、两点辨别觉[（4.6±0.3） mm]及远端指间活动度[（62.5±4.4）°]明显优于对照组[（11.8±2.2） mm、（7.5±0.6） mm、（45.3±3.6）°]，差异具有统计意义（P〈0.05）；术后6个月，观察组手指关节活动度优良率为93.55%（29/31），对照组手指关节活动度优良率为70.97%（22/31），差异有统计学意义（χ^2＝3.979，P〈0.05）。分析288例再植术患者临床资料发现，吸烟史、损伤类型、热缺血时间、离断程度、断面血栓形成情况、术后皮肤温度、指腹弹性及术后心理状态均可影响断指再植成活率（P均〈0.05）；多因素Logistic回归分析显示，影响断指再植成活率的相关因素其危险程度由高至低为重度抑郁（OR 5.698，95%CI为2.892～8.738，P〈0.001）〉完全离断伤（OR 5.389，95%CI为2.672～7.964，P〈0.001）〉热缺血时间超过6 h（OR 4.515，95%CI为1.366～8.847，P〈0.001）〉术后断面血栓形成（OR 3.287，95%CI为2.543～9.678，P〈0.001）〉术后皮肤温度低（OR 2.142，95%CI为1.243～5.212，P〈0.001）〉术后指腹弹性差（OR 2.008，95%CI为1.117～5.449，P〈0.001）。结论手指末节完全离断伤应用断指再植术治疗效果显著，可明显提高术后关节活动度，改善手指外观及功能。重度抑郁、完全离断及热缺血时间长是影响断指再植成活率的主要危险因素，针对以上因素针对性采取措施可提高断指再植成活率。

Objective To observe the clinical effect of replantation and non-finger replantation in the treatment of complete distal segment finger amputations, and to analyze the related factors affecting the survival rate of replantation of amputated finger, so as to provide an objective reference for clinical treatment.Methods From March 2015 to June 2016, sixty-two patients with complete distal segment finger amputations treated in the Third People′s Hospital of Huizhou were randomly divided into two groups： the observation group and the control group according to the random number table method.The observation group was treated with finger replantation （Pancreatic repair, orthotopic suture and stump remodeling）; the two groups of patients with early finger survival rate, replanting fingernail growth, two points discrimination, distal fingertips The clinical data of 288 patients with replantation of single finger rupture were analyzed retrospectively.The clinical data were divided into two groups： the survivors group, the survivors group 74 cases, compared the clinical data of the two groups of patients, analysis of the impact of replantation of the survival rate of the relevant factors.Results The survival rate of early finger was 8.57% （3/35） in the observation group and 15.15% （5/33） in the control group, the difference was not statistically significant （χ^2=0.216, P〉0.05）. At 6 months after operation, the length of nail growth, the two-point discrimination and the distal interphalangeal mobility were significantly better than those in the control group（（13.5±2.9）mmvs.（11.8±2.2）mm）; （4.6±0.3）mmvs.（7.5±0.6）mm; （62.5±4.4）°vs.（45.3±3.6）°） （P〈0.05）. After 6 months, the observation group The excellent and good rate of finger joint activity was 93.55% （29/31）. The excellent rate of joint activity was 70.97% （22/31） in the control group, the difference was statistically significant （χ^2=3.979, P〈0.05） 288 cases of replantation of clinical data found that smoking history, type of injury, warm ischemic time, degree of disruption, cross-section thrombosis, postoperative skin temperature, pulp elasticity and postoperative psychological status can affect the replantation （P〈0.05）. Multivariate logistic regression analysis showed that the factors affecting the survival rate of replantation of finger injury were significantly higher than those of severe depression（OR5.698, 95%CI： 2.892-8.738, P〈0.001）〉complete disconnection（OR5.389, 95%CI： 2.672-7.964, P〈0.001）〉warm ischemic time more than 6 hour（OR4.515, 95%CI： 1.366-8.847, P〈0.001）〉postoperative section Thrombosis成（OR3.287, 95%CI： 2.543～9.678, P〈0.001）〉low postoperative skin temperature（OR2.142, 95%CI： 1.243-5.212, P〈0.001）〉poor postoperative knee elasticity（OR2.008, 95%CI： 1.117-5.449, P〈0.001）.Conclusion In the treatment of patients with complete injury from the end of the finger, the effect of replantation of the finger is significantly improved, which can improve the postoperative joint activity and improve the appearance and function of the finger.The period of severe depression, complete disconnection and warm ischemia is long Affect the survival rate of finger replantation of the main risk factors for the above factors targeted measures can improve the survival rate of finger replantation.