多平面手指离断27例临床疗效分析

Clinical analysis of 27 cases of multiplane amputation of fingers

目的探讨手部多平面离断再植的临床疗效。方法自2011年11月至2021年11月我科共收治手部多平面离断患者27例,男21例,女6例;年龄23~61岁,平均41岁。双平面离断25例,其中单指双平面8例(拇指3例、示指2例、中指2例、小指1例),双指双平面4例(均为示指和中指),三指双平面3例(拇指、中指和环指1例,示指、中指和环指2例),四指双平面6例(拇指、示指、中指和环指1例,示指、中指、环指和小指5例),4例手指离断合并手掌离断(五指1例,拇指和示指1例,拇指1例,示指1例);三平面离断2例(拇指1例,示指、中指、环指和小指1例)。术后随访观察手指外观、指端感觉及手部功能恢复情况。结果27例患者共离断101个节段,完成再植97个节段,15个节段再植后发生坏死,术后随访3~42个月,平均17个月。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疗效:优8例,良13例,可4例,差2例;优良率78%。结论手部多平面离断再植较为复杂,需要多组人员合作完成,减少缺血时间,确保血管吻合的质量,提高再植的成活率,最大程度恢复再植后的功能。

Objective To explore the clinical efficacy of replantation of hand with multiplane amputation.Methods From November 2011 to November 2021,27 patients with hand multiplane amputation were admitted to our department,including 21 males and 6 females.The age ranged from 23 to 61 years,with an average of 41 years.There were 25 cases of biplane amputation,including 8 cases of single finger biplane(3 cases of thumb,2 cases of index finger,2 cases of middle finger and 1 case of little finger),4 cases of double finger biplane(both index finger and middle finger),3 cases of three-finger biplane(1 case of thumb,middle finger and ring finger,2 cases of index finger,middle finger and ring finger),6 cases of four-finger biplane(1 case of thumb,index finger,middle finger and ring finger,5 cases of index finger,middle finger,ring finger and little finger),4 cases of severed fingers and palms(1 case of five fingers,1 case of thumb and index finger,1 case of thumb and 1 case of index finger).There were 2 cases of triplane amputation(1 case of thumb,1 case of index finger,middle finger,ring finger and lttle finger).The finger appearance,fingertip sensation and hand function recovery were observed after operation.Results A total of 101 segments were severed and 97 segments were replanted in 27 patients.Necrosis occurred in 15 segments after replantation.The follow-up period was 3 to 42 months,with an average of 17 months.According to the trial standard for functional evaluation of replantation of severed fingers issued by Hand Surgery Society of the Chinese Medical Association,the results were rated as excellent in 8 cases,good in 13 cases,fair in 4 cases,poor in 2 cases.The excellent and good rate was 78%.ConclusionThe replantation of hand multiplane amputation is complex and requires the cooperation of multiple groups of personnel to reduce the ischemic time,ensure the quality of vascular anastomosis,improve the survival rate of replantation,and maximize the functional recovery after replantation.