显微镜下末节断指再植术治疗手指末节断指患者的效果观察

Effect of replantation of distal finger under microscope in treatment of patients with distal segment of finger

目的:探究显微镜下末节断指再植手术治疗手指末节断指患者的效果。方法:选取某院手指末节断指患者76例(2020年2月—2022年2月),按手术方案不同分为A组和B组,每组38例。B组患者接受常规断指再植手术治疗,A组患者接受显微镜下末节断指再植手术治疗。比较2组患者断指修复指标、手术效果、手术前后全血低切黏度(WBLSV)、全血高切黏度(WBHSV)、红细胞压积(HCT)、血浆黏度(PV)、应激指标[丙二醛(MDA)、醛固酮(ALD)、血管紧张素Ⅱ(Ang-Ⅱ)]及凝血因子(凝血因子Ⅷ、凝血因子Ⅸ)水平。结果:A组患者两点辨别觉短于B组,DIPJ大于B组,主动活动总程度评分高于B组,断指指甲长度长于B组,差异有统计学意义(P<0.05)。A组患者总有效率高于B组(P<0.05)。术后3个月,A组患者WBLSV、PV、HCT及WBHSV低于B组(P<0.05)。术后1、3 d,A组患者血清MDA水平低于B组,ALD、Ang-Ⅱ、凝血因子Ⅷ及凝血因子Ⅸ水平高于B组,差异有统计学意义(P<0.05)。结论:显微镜下末节断指再植手术治疗手指末节断指患者可优化断指修复指标、提升手术效果、调节血液流变学水平,且对机体应激指标及凝血功能影响更小。

Objective:To explore the effect of replantation of distal finger under microscope in treatment of patients with distal segment of finger.Methods:76 patients from a hospital(February 2020 ~ February 2022) were selected and divided, according to different surgery options, into group A and group B, 38 cases in each.Patients in group B received routine replantation of severed finger, and those in group A were treated with replantation of distal finger under microscope.Levels of patients in the two groups were compared in terms of replantation indexes, surgery effect, pre-and post-operative WBLSV,WBHSV, HCT, PV, stress indexes(MDA, ALD, Ang-Ⅱ), and blood coagulation factors(F-ⅷ, F-ⅸ).Results:The two-point discrimination of group A patients was shorter than that of group B patients, while DIPJ larger, total degree score of active motion higher and length of nail of severed finger longer than those of group B,the differences being of statistical significance(P<0.05).The total effectiveness of group A was higher than that of group B(P<0.05).Three months after operation, WBLSV,PV,HCT,and WBHSV of group A were all lower than those of group B(P<0.05).1d and 3d after operation, level of serum MDA of group A was lower than that of group B, while levels of ALD, Ang-Ⅱ and blood coagulation factors(F-ⅷ, F-ⅸ) were higher than those of group B(P<0.05).Conclusion:Replantation of distal finger under microscope in treatment of distal segment of finger can optimize the repair indexes of severed finger, enhance the operative effect, and regulate the level of hemorheology. What’s more, it affects less the physical stress response and coagulation function.