断指再植术后成活率及影响因素

Analysis of survival rate of replanted severed fingers and the influencing factors

目的分析断指再植术后的成活率及其影响因素。方法回顾性分析2020年1月至2023年6月行断指再植术并获得完整随访的382例断指再植患者的人口学信息,受伤相关指标及手术相关变量,分析断指再植术后的成活率及影响再植断指成活的因素。结果382例断指再植患者中男295例,女87例;平均年龄(36.4±4.7)岁,左侧多于右侧。切割伤305例,挤压伤54例,撕脱伤23例;完全离断者157例,不全离断者225例。离断平面分布中,中节指骨最多,近节指骨最少。其中成活349例,成活率为91.4%。多因素Logistic回归分析结果显示,吸烟(Or=2.14,95%CI:1.19~4.03,P=0.003)、受伤机制(Or=3.31,95%CI:2.87~6.50,P=0.000)、断指保存方式(Or=1.82,95%CI:1.12~3.77,P=0.012)、动静脉吻合比例(Or=6.83,95%CI:2.94~11.32,P=0.000)与再植术后断指是否存活相助相关。结论断指再植术后成活率约为91.4%,吸烟会增加再植术失败的风险,不同受伤机制下断指再植成活率亦不同,断指的低温干燥保存和高的动静脉吻合数量会显著增加再植断指的存活率。

Objective To analysis the survival rate of replanted severed fingers and its influencing factors.Methods Demographic information,injury related indicators and operative variables on the survival of 382 patients who underwent replantation of severed finger in our department from January 2016 to June 2019 were retrospectively analyzed.Results Among the 382 patients for replantation of severed fingers,there were 295 males and 87 females,with an average age of(36.4±4.7)years.Severed fingers on the left side were more than those on the right.There were 305 cases of cutting injury,54 cases of crush injury,and 23 cases of avulsion injury.Complete and incomplete disconnection of severed fingers were reported in 157 and 225 cases,respectively.In the distribution of disconnected planes,the middle phalanx was the most and the proximal phalanx was the least.Among them,349 survived,with the survival rate of 91.4%.Multivariate logistic regression analysis showed that smoking(OR=2.14,95%CI:1.19-4.03,P=0.003),injury mechanism(OR=3.31,95%CI:2.87-6.50,P=0.000),finger preservation(OR=1.82,95%CI:1.12-3.77,P=0.012),and arteriovenous anastomosis ratio(OR=6.83,95%CI:2.94-11.32,P=0.000)were significantly correlated with the survival of severed fingers after replantation.Conclusion The survival rate of replanted severed finger in our study is about 91.4%.Smoking increases the risk of replantation failure.The survival rate of replanted severed finger differs by injury mechanisms.Low temperature and drying preservation of severed fingers and the high number of anastomoses significantly increase the survival rate of replanted fingers.