“Z”字改形加压缝合法治疗手指末节Ⅲ型离断的疗效观察

Clinical observation of "Z" shape modified compression suture in the treatment of type Ⅲ amputation of finger distal segment

目的探讨手指末节Ⅲ型离断“Z”字改形加压缝合的治疗方法及临床效果。方法自2017年8月至2019年4月,我们对28例手指末节Ⅲ型离断无再植条件或不接受再植的患者进行“Z”字改形加压原位缝合,指骨不固定,术后辅助高压氧,阿司匹林及预防感染治疗。结果术后28例中22例完全存活,2例指尖坏死,脱痂后瘢痕愈合,成活率85.7%。4例坏死,其中3例坏死组织脱落后换药愈合,1例行截指术。按照中华医学会手外科学会断指再植功能评定试用标准评定优良率达92.8%。结论对末节Ⅲ型断指,采用改良的原位缝合,方法简单,成活率高,术后外形功能满意。

Objective To investigate the treatment method and clinical efficacy of“Z”shape modified compression suture for typeⅢfinger distal segment amputation.Methods From August 2017 to April 2019,28 patients with typeⅢamputation of finger distal segment without replantation conditions or without acceptance of replantation were treated with“Z”shape modified compression in situ suture without fixation of phalanx.Hyperbaric oxygen,aspirin and prevention of infection were given postoperatively.Results Among the 28 cases,22 cases survived completely and 2 cases had fingertip necrosis.The scar healed after scab removal,and the survival rate was 85.7%.There were 4 cases of necrosis.Among them,3 cases had necrotic tissue falling off and healed after dressing change,and l case underwent finger amputation.According to the evaluation standard of replantation function of severed fingers issued by Hand Surgery Society of Chinese Medical Association,the excellent and good rale was 92.8%.Conclusion The application of modified in situ suture in the trealment of type amputation of finger distal segment is a simple method with high survival rate and satisfactory postoperative appearance and function.