断指再植患者术后患指早期坏死的影响因素分析

Analysis of Influencing Factors of Early Necrosis of Affected Fingers after Replantation of Severed Fingers

目的:探讨断指再植患者术后患指早期坏死的影响因素。方法:回顾性分析2016年1月—2022年12月贵州医科大学附属乌当医院收治的67例断指再植患者的临床资料,所有患者均行断指再植术治疗,术后7 d依据患指是否出现早期坏死分为早期坏死组与非早期坏死组。收集两组年龄、性别、吸烟史、饮酒史、合并糖尿病、合并高血压、指别、术前缺血时间、血管痉挛、受伤类型、术后感染、术后皮肤温度等多方面基础资料,先行单因素分析,获得差异有统计学意义的项目后再行logistic回归分析,获得影响断指再植术后患指早期坏死的高危因素。结果:67例患者,术后共出现早期坏死13例,患指早期坏死率为19.40%(13/67)。两组吸烟史、指别、术前缺血时间、血管痉挛、受伤类型、术后感染、术后皮肤温度比较,差异有统计学意义(P<0.05);两组年龄、性别、饮酒史、合并糖尿病、合并高血压比较,差异无统计学意义(P>0.05)。多因素分析显示,有吸烟史(OR=7.255,95%CI:1.767,29.782)、指别小指(OR=7.040,95%CI:1.897,26.130)、术前缺血时间≥8 h(OR=15.714,95%CI:3.095,79.798)、有血管痉挛(OR=5.850,95%CI:1.563,21.894)、受伤类型挤压伤(OR=5.667,95%CI:1.393,23.059)、有术后感染(OR=5.600,95%CI:1.544,20.312)、术后皮肤温度低温(OR=7.096,95%CI:1.872,26.906)为影响断指再植患者术后患指早期坏死的高危因素(OR>1,P<0.05)。结论:断指再植患者术后患指存在一定早期坏死风险,与有吸烟史、指别小指、术前缺血时间≥8 h、有血管痉挛、受伤类型挤压伤、有术后感染、术后皮肤温度低温关系密切,还需早期做好预防处理,避免患指坏死。

Objective:To explore the influencing factors of early necrosis of affected finger after replantation of severed fingers.Method:The clinical data of 67 patients with replantation of severed fingers who admitted to Wudang Hospital Affiliated to Guizhou Medical University from January 2016 to December 2022 were retrospectively analyzed,all patients were treated with replantation of severed fingers,they were divided into the early necrosis group and the non-early necrosis group according to whether early necrosis occurred at 7 d after operation.The basic data of age,gender,smoking history,drinking history,diabetes mellitus,hypertension,fingering,preoperative ischemia time,vasospasm,injury type,postoperative infection,postoperative skin temperature and other aspects of two groups were collected,univariate analysis was performed first to obtain items with statistically significant differences,and then logistic regression analysis was performed to obtain the high-risk factors affecting early necrosis of the affected finger after replantation of severed fingers.Result:Among 67 patients,there were 13 cases of early necrosis after operation,and the early necrosis rate of the affected fingers was 19.40%(13/67).There were significant differences in smoking history,fingering,preoperative ischemia time,vasospasm,injury type,postoperative infection and postoperative skin temperature between two groups(P<0.05);there were no significant differences in age,gender,drinking history,diabetes mellitus and hypertension between two groups(P>0.05).Multivariate analysis showed that:smoking history(OR=7.255,95%CI:1.767,29.782),little finger(OR=7.040,95%CI:1.897,26.130),preoperative ischemia time≥8 h(OR=15.714,95%CI:3.095,79.798),vasospasm(OR=5.850,95%CI:1.563,21.894),crush injury of injury type(OR=5.667,95%CI:1.393,23.059),postoperative infection(OR=5.600,95%CI:1.544,20.312),postoperative skin temperature low temperature(OR=7.096,95%CI:1.872,26.906)were the high risk factors for early necrosis of the affected finger after replantation(OR>1,P<0.05).Conclusion:There is a certain risk of early necrosis of the affected finger after replantation of severed finger,which is closely related to smoking history,little finger,preoperative ischemia time≥8 h,vasospasm,crush injury of injury type,postoperative infection and postoperative skin temperature low temperature,early prevention and treatment are needed to avoid necrosis of affected limb.