修复大鱼际肌的掌骨平面拇指离断再植

Replantation of severed thumb on metacarpal plane with repair of thenar muscle

目的探讨修复大鱼际肌的掌骨平面拇指离断再植的临床疗效。方法自2014年12月至2018年3月,对9例急诊伴有大鱼际肌损伤的掌骨平面拇指离断患者实施再植。结果9例掌骨平面离断指均Ⅰ期存活,其中3例出现肌腱粘连,术后3个月予肌腱松解术。术后随访3~15个月,平均10个月。再植指没有旋转、成角畸形,大鱼际肌饱满;8例拇对掌功能:拇指指间关节掌侧纹到第三掌骨远侧掌横纹之间最大距离为5~8 cm。5例再植指总主动活动度大于健侧75%,4例再植指总主动活动度大于健侧50%;7例再植指指体皮肤色泽、温度正常,张力适中,毛细血管反应灵敏,2例色泽稍差,温度略低,怕冷;指腹两点分辨觉7~9 mm,感觉恢复至S3~S3+。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拇指功能:优5例,良3例,可1例。结论伴有大鱼际肌损伤的第一掌骨平面拇指离断伤进行再植,存活后外观和功能良好。在患者全身情况允许、离断指体完整的前提下,熟悉拇指解剖及变异,术前充分评估受伤情况,可提高掌骨平面拇指离断再植的临床疗效。

Objective To explore the clinical efficacy of replantation of severed thumb on metacarpal plane with repair of thenar muscle.Methods From December 2014 to March 2018, 9 cases of thumb amputation on metacarpal plane with thenar muscle injury were replanted in emergency.Results All the 9 cases of severed thumb on metacarpal plane survived uneventfully. Tendon adhesion occurred in 3 cases and the tendon release was performed 3 months after operation. The patients were follow-up for 3 to 15 months, with an average of 10 months. There was no rotation and angulation of the replanted thumbs, and thenar muscles were full. The function of thumb opposition in 8 cases: the maximum distance between the palmar striation of thumb interphalangeal joint and the palmar striation of the distal third metacarpal bone was 5 to 8 cm. The total active activity of 5 replanted thumbs was greater than that of the healthy side by 75%, and that of 4 replanted thumbs was greater than that of the healthy side by 50%. The skin color and temperature of 7 replanted thumbs were normal, moderate in tension, sensitive in capillary response, and the skin color of 2 replanted thumbs was slightly worse, slightly lower in temperature, and afraid of cold. The two-point discrimination of finger pulp was 7 to 9 mm, and the sensation was restored to S3 to S3+ . According to the evaluation standard of replantation function of severed fingers of Hand Surgery Society of Chinese Medical Association, the function of replanted thumb was evaluated as excellent in 5 cases, good in 3 cases, fair in 1 case.Conclusion The replantation of severed thumb on metacarpal plane with repair of thenar muscle showed good appearance and function. On the premise that the patient′s whole body condition allows and the severed finger body is complete, familiar with the thumb anatomy and variation, and fully evaluation of the injury before operation can improve the clinical efficacy of thumb replantation on metacarpal plane.