特殊类型断指再植的临床总结

目的 总结特殊类型断指的再植方法及临床效果。方法 对手指末节及指尖离断、多指及多平面离断、辗压性离断、旋转撕脱及套脱离断、小儿断指及手指复合小组织块离断伤，根据不同的伤情采用不同的方法再植。结果 再植234例，存活228例，成活率97．4％。其中186例经3个月～4年随访，功能恢复优良率88．4％。结论 各种特殊类型的断指，应用显微外科技术进行再植，均可取得很高的成活率。再植指外形与功能康复是判定是否再植的主要标准。     

特殊类型断指再植的治疗

目的探讨特殊类型断指再植的方法和疗效。方法根据末节断指、小儿断指、撕脱性离断断指、多指离断及多段离断断指,采用不同的方法再植。结果共176例再植220指,成活214指,成活率97．27％。术后经2月～6年的随访,按中华医学会手外科学会断指再植功能评定试用标准评定：优125指,良78指,差17指,优良率92．27％。结论特殊类型断指采用合适的方法再植,可获得较高的成活率及较好的外形与功能。     

手指脱套伤显微外科修复临床应用研究

目的 探讨手指脱套伤的修复方式。方法 通过对4例放弃再植的脱套性断指进行解剖研究,显微镜下观察离断手指的血管损伤情况,同时回顾性分析单个手指脱套性损伤的修复情况。结果本组33例35指,其中脱套性断指11例12指,再植成活10指;采用带感觉神经静脉网动脉化皮瓣移植修复拇及食指脱套性损伤6例7指;掌背动脉逆行岛状皮瓣修复中、环及小指损伤16指,功能恢复良好。结果 脱套性离断手指只要离断的指体完整,仍有再植的条件,同时依据不同手指脱套伤的不同损伤状况,采用不同的修复方法,获得良好的效果。     

467例734个复杂性断指再植方法的选择与探讨

目的 探讨复杂性断指的分型及再植方法。方法 对467例734个复杂性断指依照伤情和术式结合的方法进行分类。对旋转性断指、脱套性断指、多节段性断指、伴皮肤神经血管缺损的断指、伴部分复合组织块缺损的断指、指尖离断及多指离断，分别采用不同的方法进行再植。结果 734个断指再植后存活721指，存活率达98．3％。术后随访到418例，共随访6～13个月。以最后1次随访结果为准，按中华医学会手外科学会断指再植功能评定试用标准评定，优284例，良95例，差39例，优良率达到90．7％。结论 复杂性断指的再植方法各异，正确判断伤情，选择最佳的手术方案是保证手术成功的重要前提。     

撕脱性断指再植的临床应用

近年来，各种特殊损伤类型的断指再植成功率得到了明显的提高。一般认为撕脱性离断的血管无法使用吻合，而我们在临床中发现，许多非切割性离断手指的血管均存在不同程度的损伤，保留并吻合这些血管后断指再植也获得了成功。因此，我们在各种严重损伤的断指中尝试使用撕脱性离断的血管进行吻合并获得了成功。     

旋转撕脱性断指再植14例报告

旋转撕脱性断指的创伤较重，成活率较低。我院自1999年以来共完成手指旋转撕脱性离断伤再植术14例24指，再植成功20指，功能满意。     

挤压旋转撕脱性断指再植方法的选择

目的 报道挤压旋转撕脱性断指再植不同手术方法的临床效果。方法 1993年5月-2002年6月，对挤压旋转撕脱性手指完全离断实施断指再植66例72指，其中应用自体小静脉移植17例23指，采用掌、指固有动脉全段移位10例10指，进行邻指指固有动脉远端血管局部转位39例39指。结果 自体小静脉移植组的断指再植成活9例13指，采用掌、指固有动脉全段移位再植成活9例9指，1例部分成活，而进行邻指指固有动脉远端血管局部转位的39例39指全部成活。所有成活病例术后随访6个月～5年，按对断指再植功能标准评定，三种手术方法优良率分别为68．8％、86．7％、95．6％。结论 挤压旋转撕脱性手指完全离断，应用邻指指固有动脉远端血管局部转位治疗效果良好，是一种实用有效的再植方法。     

手指末节断指再植320例临床分析

目的探讨手指末节离断伤断指再植的手术治疗效果。方法对320例断指患者采用急诊在显微镜下进行断指再植手术。结果手指离断伤386指经再植手术后,成活325指,坏死42指,局部感染19指,成活率为84．2％,术后患指功能及外观恢复均较满意。结论手指末节离断伤断指再植是在恢复患指正常解剖的基础上重建血液循环,其目的是达到恢复再植手指的功能和外观。     

手指多平面离断再植及康复

目的研究手指多平面创伤离断再植及康复。方法由于手指多平面离断,创伤严重,伤情复杂,手术部位多,再植难度大、技术要求高,不同于一般手指离断创伤与再植,是断指再植中一种特殊类型。结果我院共统计此类病例31例,成功28例,成功率90．32％。结论我们就多平面离断再植的逐项特点及术后的康复问题进行了探讨,为临床治疗提供理论依据。     

36例复杂性断指再植治疗体会

目的 探讨修复手指严重破坏性损伤，离断，恢复原手指的正常功能与外形的方法。方法 彻底清创，采用血管移植或皮瓣游离移植，手指移位再植修复。结果 经6个月－6年随访，36例患者再植手指全部存活，恢复了原有手指正常功能。结论 彻底清创，熟练运用显微外科手术，精确吻合血管是严重毁损断指再植修复成功的关键。     

The results of replantation after amputation of a single finger

We reviewed fifty-nine consecutive cases of patients who had replantation of a single finger (excluding the thumb) after traumatic amputation, with an average follow-up of fifty-three months. Fifty-one (86 per cent) of the replanted fingers survived. Survival was found to be affected by the age of the patient, the number of vessels that were anastomosed, and the replantation experience of the surgeons. The survival rate was not affected by the gender of the patient, the mechanism of injury, or which finger was amputated. As compared with survival only, the functional results were most dependent on the level of amputation. The proximal interphalangeal joint in amputated fingers that were replanted distal to the insertion of the flexor superficialis tendon had an average range of motion of 82 degrees after replantation, while those amputated proximal to the insertion had an average range of motion of only 35 degrees after replantation. The average operating time was six hours and ten minutes, and the average time until the patient returned to work was 2.3 months. Based on this experience, it is our opinion that replantation of a single finger that was amputated distal to the insertion of the flexor superficialis tendon is justified, but that replantation of a single finger that was amputated proximal to this insertion is seldom indicated.     

缺乏可供吻合静脉的指尖离断再植方法选择

目的:探讨缺乏可供吻合静脉的指尖离断再植方法。方法:自2004年11月至2009年11月,对86例104指指尖离断患者进行再植,其中男64例,女22例;年龄2～64岁,平均26岁。伤后至就诊时间30min～12h,断指缺血时间2.5～12h,术前各项检查均未见明显异常。采用4种再植方法:①吻合双侧指固有动脉,指根部结扎一侧指固有动脉的断指再植,37指;②动-静脉转流方式的断指再植,27指;③只吻合指动脉的断指再植,24指;④去表皮囊袋法再植,16指。结果:86例104指,成活102指,伤指成活病例中75例(92指)获得随防,时间6～24个月。按中华医学会手外科学会断指再植术后功能评定试用标准评定:优52例,良19例,差4例。结论:依据显微镜下清创所见离断指尖动脉损伤状况,选用不同的再植方式,有助于扩大指尖再植适应证,提高再植成功率。     

86例末节断指再植的临床分析

目的 总结86例126指末节断指再植的临床治疗及疗效.方法 在放大16倍的手术显微镜下对末节离断指进行清创,按常规的骨折内固定、缝合断裂的肌腱等再植顺序,分别对Ⅰ型、Ⅱ型、Ⅲ型病例进行再植,血管缺损者行静脉移植,未吻合静脉或静脉回流欠佳者术后行放血等处理.结果 114指顺利存活,成活率为90.5%.术后随访见再植指外形饱满,痛、温觉恢复,指腹两点分辨觉为6～8 mm,患指远指间关节屈、伸活动正常.结论 末节断指行再植可恢复美观的外形和良好的功能,应尽可能行再植手术,血管缺损者可取静脉移植,未吻合静脉或回流欠佳者行放血疗法等可提高断指的成活率.     

特殊类型断肢（指）再植的临床研究

探讨特殊类型断肢(指)的再植方法。方法:对468例9种特殊类型的断肢(指),采用原位、移位、缩短再植;胫后动脉皮瓣桥接肱动脉再植;邻指血管神经肌腱转移替代再植;无血再植;吻合离断关节复合组织体及其与肢体近远端离断的血管、神经等方法进行再植。结果:再植成功率达93％,功能恢复优良率达86％。结论:通过临床应用上述再植方法,扩大了肢(指)体毁损性离断伤,多指多平面离断伤,关节复合组织体离断伤,小儿及老年人肢(指)体离断伤等的再植指征。探索出对特殊类型断肢(指)再植的新方法。     

Current procedures in China on replantation of severed limbs and digits

Since the first successful replantation of a severed right hand was reported in 1963, surgeons in China have performed more than 3735 replantations of limbs and digits with increasing improvement in the survival rate. Of special interest is that local hospitals have reported numerous successful cases revealing a popularization of this kind of operation in China. The replantation survival rate is related to the type of injury and duration of anoxia. The types of injury include avulsion or crush amputation, severed distal segments of fingers, immersion conditions, amputated limbs or digits in children, and segmental resection of diseased tissues. The results are analyzed by a special system of functional evaluation.     

手指侧方组织块完全离断再植的临床体会

目的:探讨对手指侧方组织块完全离断行再植手术的必要性及方法。方法 :2012年3月至2015年4月,对62例各种原因导致手指组织块完全离断患者的治疗进行回顾性分析,其中男34例,女28例;年龄17~52岁,平均29.1岁。其中拇指27例,示指15例,中指13例,环指8例,小指2例,其中2指合并受伤3例,14例累及远侧指间关节;受伤至治疗时间30 min~2 h,平均1 h。全部采用急诊行再植术。术后随访观察手指外观、指端感觉及患指功能恢复情况。结果:62例完成手术者中58例成活,成活指随访3~15个月,平均6.5个月,按照中华医学会手外科学会上肢部分断指再植功能评定试用标准评定疗效,优52例,良3例,可3例,优良率94.8%。结论:对于手指侧方组织块离断再植存活后外观和功能良好,只要患者全身情况允许,远离断的指体尚完整,有可供吻合的血管和神经,都应力争对其进行再植。     

A Unique Case of Replantation of Previously Replanted Fingers

Replantation of digital amputations is now the accepted standard of care. However, rarely will a replantation surgeon be presented with amputated fingers which have been previously replanted. In our literature search, we could find only one publication where a replanted thumb suffered amputation and was successfully replanted again. We report the technical challenges and the outcome of replanting two fingers which suffered amputation 40 months after the initial replantation and were successfully replanted again. Replantation was critical since the amputated fingers were the only two complete fingers in that hand which had initially suffered a four-finger amputation. The second-time replantation of previously replanted fingers is reported to allay the concern of the reconstructive surgeon when faced with this unique situation of “repeat amputation of the replanted finger.” Second-time replantation is feasible and is associated with high-patient satisfaction. Replantation must be attempted especially in the event of multiple digit amputations.     

Nonsurgical factors of digital replantation and survival rate: A metaanalysis

The aim of this metaanalysis was to evaluate the association between nonsurgical factors and survival rate of digital replantation. A computer search of MEDLINE, OVID, EMBASE and CNKI databases was conducted to identify literatures for digital replantation, with the keywords of “digit,” “finger” and “replantation” from their inception to June 10, 2014. Based on the inclusion and exclusion criteria, data were extracted independently by two authors using piloted forms. Review Manager 5.2 software was used for data analysis. The effect of some nonsurgical factors (gender, age, amputated finger, injury mechanisms, ischemia time and the way of preservation) on the survival rate of digital replantation was assessed. The metaanalysis result suggested that gender and ischemia time had no significant influence on the survival rate of amputation replantation. However, the survival rate of digital replantation of adults was significantly higher than that of children. The guillotine injury of a finger was easier to replant successfully than the crush and avulsion. The little finger was more difficult for replantation than thumb. Survival rate of fingers stored in low temperature was higher than that in common temperature. The present metaanalysis suggested that age, injury mechanism, amputated finger and the way of preservation were significantly associated with the survival rate of digital replantation.