多指离断再植的体会

目的总结手部多指完全离断再植成功经验。方法 2013年6月—2016年3月西南医科大学附属中医医院手外科成功再植多指离断30例,男性17例,女性13例;年龄2~63岁,平均32.5岁。单手多指离断26例,其中2指离断10例,3指离断9例,4指离断5例,5指离断2例。双手各1指离断2例,各3指离断2例。应用显微技术,按照先清创-骨折复位内固定(克氏针贯穿或交叉内固定)-修复指伸肌腱-修复指屈肌腱-吻合指固有动脉及指固有神经-吻合指腹部静脉-吻合指背部静脉-缝合皮肤关闭创面的顺序完成所有断指的再植。术后进行科学康复训练并坚持随访3~18个月,结合文献分析多指离断再植成活和功能恢复的经验。结果本组30例患者均获随访,术后3个月回访,再植手指愈合良好,外形美观;术后12个月回访,再植手指皮肤感觉恢复正常,再植手指握、捏及对掌功能部分恢复。末次回访时,参照中华医学会手外科学分会断指再植功能评定试用标准评价疗效,本组(85.3±2.5)分,优21例、良6例、差3例。除坏死3指外,均未出现指体创面感染、骨折不愈合等并发症。术后发生动脉危像3指,经手术探查后解除。并发肌腱粘连5指,术后6个月后行肌腱松解术后手指屈伸功能恢复。结论多指离断再植成功不仅需要周密的计划安排和团队的合作,而且关键在于高超的血管吻合技术。

The experience of successful replantation of multiple fingers

Objective To summarize the experience of successful multiple digital replantation.Methods From Jun.2013 to Mar.2016,30 patients with multiple figure injuries were successfully replanted in the Second Affiliated Hospital of Southwest Medical University,including 17 males and 13 females,with an average age of 32.5 years （range，2 -63 years old）.Twenty-six cases received fingers replantation in one-hand，including 2 fingers in 10 cases，3 fingers in 9 cases，4 fingers in 5 cases，and 5 fingers in 2 cases.Two cases had one finger in each hand.Two cases had replantation in both hands ，with three fingers in each hand.Microscopy technique was applied，with the following procedure including debridement ，fracture reduction internal fixation （Kirschner's needle penetration or cross-internal fixation），repair of the extensor tendon，repair of the flexor tendon， anastomosing finger artery and finger nervous proprii，anastomosing the abdominal vein，anastomosing the dorsal vein，suturing skin and closing the wound.Postoperative scientific rehabilitation training was applied and patients were followed up for 3 to 18 months. Results All the 30 patients in this group were followed up.After 3 months of follow-up，the replanted fingers healed well and the appearance was good .After 12 months of follow-up，the finger skin feeling restored normal，and some function of the finger including grip，pinch and palm was restored.At the last follow-up，the efficacy was evaluated according to the evaluation criteria of severed finger replantation function of the Hand Surgery Branch of the Chinese Medical Association.The average score of this group was （85.3 ±2.5）points，including 21 cases of excellent， 6 cases of good，and 3 cases of poor.Except for 3 necrosis，no complication such as finger wound infection or fracture nonunion occurred.Arterial crisis occurred in 3 fingers，and was relieved after surgical exploration.Simultaneously，5 cases of tendon adhesions were observed ，and the finger flexion and extension function was restored after tendon release at 6 months after operation.Conclusion The success of multi-finger replantation not only requires careful planning and team cooperation，but also requires experienced vascular anastomosis .