末节断指再植的功能评价

目的报道末节断指再植的远期功能效果.方法对38例42指末节断指再植成功者进行了平均2年3个月(10个月～4年6个月)的随访.结果拇指指间关节与手指远侧指间关节的平均主动活动度分别为49°和52°,两点辨别觉平均7.2mm.根据Tamai标准评价功能结果,42指中优25指,良17指.结论应强调精确吻合指神经的必要性,仅吻合一根指神经或不吻合指神经者感觉恢复较差;对累及关节的离断以关节融合为佳;再植后的萎缩为充盈不良或失用所致.

Functional recovery of distal phalanx replantation

Objective To report the long term functional results of distal phalanx replantation. Methods 42 successfully replanted fingers in 38 patients were available and followed-up for an average of 27 months(10 -54 months). Results The average active range of motion in the interphalangeal joint of thumb(IP) and in the distal interphalangeal joint of fingers(DIP), excluding those arthrodesed, were 49 degrees and 52 degrees. Sensory assessment showed a mean of 7.2 mm two-point discrimination(2PD). According to Tamai's scoring criteria, the functional results of 42 fingers were 25 excellent and 17 were good. Conclusion Accurate primary nerve repair is essential, patients in whom only one nerve repaired or without nerve repaired have a relative bad sensory recovery. Arthrodesis should be attempted when the amputation occured through the distal interphalangeal joint. Postreplantation atrophy might be due to inadequate perfusion or disuse.