手指脱套离断伤再植的治疗体会

Treatment of Replantation of Degloving and Severed Fingers

目的:探讨手指脱套离断伤再植的治疗效果及注意事项。方法:对31例32指脱套性离断手指进行再植,在显微镜下进行彻底清创,解剖指固有动脉到正常处,标记血管、神经,克氏针固定骨折,吻合指背(掌)侧静脉、指固有动脉、指固有神经,术后常规进行抗炎、抗凝、抗痉挛等治疗。结果:术后32指成活30指,2指坏死,成活率93.8%。随访28例29指(1例失访),随访时间6个月~3年,再植手指外形和指甲生长良好,指端两点分辨觉为4~10 mm。结论:手指脱套离断伤再植不确定因素较多,只要脱套组织中能找到可供吻合的血管,遵照注意事项,都能通过再植的方法进行治疗,恢复手指的功能及外形。

Objective To investigate the therapeutic effect and precautions of replantation of degloving and severed fingers.Methods 31 cases of 32 degloving severed fingers were replanted.Thorough debridement was carried out under the microscope.The proper digital artery was dissected to the normal place,and the blood vessels and nerves were marked.The fracture was fixed with Kirschner wire.The dorsal(metacarpal) vein,proper digital artery and proper digital nerve were anastomosed. The postoperative routine treatment was anti-inflammatory,anticoagulant and antispasmodic. Results 30 fingers survived of 32fingers and 2 fingers were necrotic.The survival rate was 93.8%. 29 fingers of 28 cases(1 case lost) were followed up for 6months to 3 years.The shape and nail growth of the replanted fingers were good,and the two-point resolution of the fingertip was 4-10 mm. Conclusion There are many uncertain factors in the replantation of severed fingers.As long as the anastomotic blood vessels can be found in the degloving tissue,according to the precautions,replantation should be used to restore the function and shape of the fingers.