手部多平面离断再植及康复

Replantation and rehabilitation of multi-planar disarticulation injuries of hand

目的 探究手部多平面离断伤再植术及康复方法。方法 自2014年4月至2021年1月,苏州大学附属瑞华医院手外科对15例(58段)手部多平面离断伤患者进行再植术。其中断腕、断掌并断指1例(3段),断腕并断掌2例(4段),断掌并断指6例(29段),手指多平面离断6例(22段)。行术前评估,术后指导患者进行康复训练治疗。结果 15例(58段)肢体中54段再植肢体成活,再植成活率为93.1%。术后随访3~20个月,平均9个月。再植成活肢体皮肤质地较好,外形饱满,感觉恢复S2~S4,两点分辨觉6~12 mm。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体功能,手功能优良率为80%。结论 手部多平面离断伤经术前评估、术中快速再植和术后康复训练可获得满意的成活率和临床疗效。

Objective To explore the methods of replantation and rehabilitation of multi-planar disarticulation injuries of hand.Methods From April 2014 to January 2021, 15 patients with multi-planar disarticulation injuries of hand(58 segments) underwent replantation surgery. There were 1 case of broken wrist, broken palm and broken finger(3 segments), 2 cases of broken wrist and broken palm(4 segments), 6 cases of broken palm and broken finger(29 segments) and 6 cases of multi-planar disarticulation injuries of fingers(22 segments). Preoperative evaluation and postoperative rehabilitation training were performed. Results In 15 patients(58 segments),54 segments were replanted and survived. The survival rate of replantation was 93.1%. The postoperative follow-up ranged from 3 to20 months, with an average of 9 months. The replanted segments had good skin texture and appearance. The sensory recovery was from S2 to S4 and the two-point discrimination was from 6 to 12 mm. According to the trial standard of the Chinese Society of Hand Surgery for the evaluation of function of the replanted finger, the excellent and good rate of hand function was 80%. Conclusion Preoperative evaluation, intraoperative rapid replantation and postoperative rehabilitation of multi-planar disarticulation injuries of hand can achieve satisfactory survival rates and clinical outcomes.