节段毁损性断指(拇)短缩再植的疗效观察

Clinical efficacy of replantation after shortened for segmental destructive amputated fingers / thumbs

目的评价手(拇)指节段毁损性断指(拇)再植术后的功能效果。方法我院于2004年3月~2013年3月收治18例22指,男性14例,女性4例;年龄6~56岁,平均33.2岁。其中拇指5指,示指8指,中、环指各4指,小指1指。清创时尽量保留靠近关节侧的组织,对近中节毁损后残留近节基底病例,清创后需保留近节基底至少0.5cm骨质,以保证掌指关节的完整性。拇指清创后其再植后长度需>2cm,有血管缺损者行自体血管移植,神经缺损者可行二期神经移植,神经自指总神经部撕脱者行神经端侧吻合。结果除1例示、中指离断伤指节毁损严重,行中指异位示指再植,其余均行短缩再植。成活率为90.48%。再植手指较健指平均短2.1cm(1.2~3.5cm),术后随访18~51个月,优良率为68.42%。结论对掌指关节完整、有一个节段以上的指体相对完整,并可能恢复神经感觉的毁损性断指(拇),均有再植指征。

Objective To investigate the efficacy of replantation of segmental amputated fingers/thumbs.Methods Twenty-two amputated fingers in 18 patients were replanted in our hospital from Mar. 2004 to Jan. 2013( 14 males and 4 females; mean age,33. 2 years; range,6 to 56 years). Among them,there were 5 cases of thumb amputation,8 cases of index finger amputation,4 cases of middle finger amputation as well as ring finger amputation and 1 case of thumb amputation. To make the metacarpophalangeal joint( MCJ) intact,the debridement was performed with uttermost preservation of tissue nearby the joint. For destructive amputated finger at the proximal and middle phalanx level with the base of proximal phalange survived,the base was reserved for at least 0. 5cm to preserve its integrity. The thumb was longer than 2cm after replantation. The defect of blood vessels was repaired by free graft of autologous veins. Nerve graft was performed in case of nerve avulsion. The amputated digital nerves were anastomosed to common digital nerves in an end-to-side fashion. Results All cases were shortened and replanted except for one with destructive amputation of index finger and middle finger,who underwent heterotopic replantation. The survival rate was 90. 48 percent. The fingers were shortened for an average of 2. 1cm( range,1. 2 to3. 5cm). The patients were followed-up for 18 to 51 months. The overall excellent and good rate was 68. 42%.Conclusion The outcome of the cases demonstrates that replantation should be attempted for segmental amputated fingers with intact metacarpophalangeal joint and nerve restoration potentiality.