拇指末节离断再植存活率的相关影响因素分析

Analysis in related influencing factors for survival rate of replantation of distal thumb amputation

目的分析拇指末节离断再植存活率的相关影响因素。方法回顾性分析2014—2020年在本院行断指再植的106例单侧拇指末节完全离断患者的临床资料。术后6个月随访时,评估患者再植拇指的指甲长度、指间关节活动度、指尖的两点辨别感觉。分析影响再植成功率的相关因素。结果术后6个月时,再植末节拇指的指甲长度为(10.4±1.7)mm,指间关节活动度为(59.3±5.2)°,指尖的两点辨别距离为(5.8±0.9)mm。本研究106例患者再植存活率为84.9%。单因素分析结果显示,年龄、手术时间、热缺血时间、锐器切割伤情况是影响再植成功率的相关因素(P<0.05)。多因素二元Logistic回归分析提示,年龄≥45岁、手术时间≥2.8 h、热缺血时间≥6 h以及非锐器切割伤是影响再植存活率的独立危险因素(P<0.05或P<0.01)。结论年龄≥45岁、手术时间≥2.8 h、热缺血时间≥6 h以及非锐器切割伤是影响再植存活率的独立危险因素。因此,处理拇指末节断指时应采取针对性的治疗方案。

Objective To analyze the related influencing factors for survival rate of replantation of distal thumb amputation.Methods The clinical materials of 106 patients with unilateral complete distal thumb amputation undergoing replantation of severed fingers in authors′hospital from 2014 to 2020 were retrospectively analyzed.At the follow-up of 6 months after operation,the nail length of replanted thumb,range of motion of interphalangeal joint and two-point discrimination of fingertip were evaluated.Related influencing factors for the success rate of replantation were analyzed.Results At 6 months after operation,the length of fingernail of replanted distal thumb was(10.4±1.7)mm,the range of motion of interphalangeal joint was(59.3±5.2)°,and the two-point discrimination distance of fingertip was(5.8±0.9)mm.The survival rate of replantation in 106 patients was 84.9%.Univariate analysis showed that age,operation time,warm ischemia time and sharp cutting injury were the related factors affecting the success rate of replantation(P<0.05).Multivariate binary Logistic regression analysis showed that age≥45 years old,operation time≥2.8 h,warm ischemia time≥6 h and non-sharp cutting injury were the independent risk factors for survival rate of replantation(P<0.05 or P<0.01).Conclusion Age≥45 years old,operation time≥2.8 h,warm ischemia time≥6 h and non-sharp cutting injury are the independent risk factors for survival rate of replantation.Therefore,a targeted treatment plan should be adopted when dealing with distal thumb amputation.