肌腱原位缝合在撕脱性断指再植术中的应用

Application of tendon suture in situ in replantation of avulsed severed finger

目的探讨肌腱原位缝合在撕脱性断指再植术中的应用及临床疗效。方法自2014年6月至2018年2月,我们对7例肌腱由肌腹抽出性断指患者,采用经原隧道原位包埋缝合法修复抽出肌腱进行断指再植。结果本组7例患者术后伤口均I期愈合,离断指体再植成功,术后未出现血管危象。所有患者均获得随访,时间为6-20个月,平均10个月。再植指体血运良好,外形良好,指腹饱满,屈伸、对指功能满意。指腹两点分辨觉为8-14mm。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再植指功能:优5例,良1例,可1例。前臂仅留线性瘢痕,手腕屈伸活动不受限。结论通过对撕脱性断指抽出肌腱采用经原隧道原位包埋缝合修复,并对伴有指动脉、神经缺损的患者也可于前臂同一切口内切取浅静脉及皮神经桥接修复,术后可以获得满意的效果。

Objective To explore the surgical method and clinical efficacy of tendon in situ suture in the replantation of avulsed severed finger. Methods From June 2014 to February 2018, 7 cases of severed finger with tendon pulled out from the abdomen were repaired and replanted by in situ embedding suture through the original tunnel. Results All the wounds achieved primaiy healing and the replantation of severed fingers was successful. There was no vascular crisis after operation. All the patients were follow-up for 6 to 20 months, with an average of 10 months. The replanted finger has good blood supply, good appearance, full belly, and satisfactory function of flexion, extension and opposition. The two-point discrimination of finger pulp was 8 to 14 mm. According to the evaluation criteria of replantation function of severed fingers issued by Hand Surgery Society of Chinese Medical Association, the results were rated as excellent in 5 fingers, good in 1 finger, and fair in 1 finger. Only linear scars were left on the forearm, and wrist flexion and extension were not limited. Conclusion The tendon of avulsed severed finger can be repaired by suture in situ via the original tunnel. The superficial vein and cutaneous nerve can also be harvested from the same incision of forearm to repair the defect of digital artery and nerve. Satisfactory results can be obtained after operation.