多指节段性毁损性离断再植

目的 扩大断指再植适应证,提高断指再植术后功能的恢复。方法 1996年2月-1999年8月,对8例23指节段性毁损性断指进行缩短再植,骨支架行克氏针固定,18指修复了指伸、屈肌腱,每指均吻合单侧（6指）或双侧（17指）指固有神经,动、静脉吻合比为1：2或2：3,血管缺损5指8条,行自体静脉游离移植,结果 8例23指再植全部成活,5指二期行DIP融合术,术后随访10-18个月,1指锤状指畸形,余各指痛,温觉恢复,两点辨别觉6-12mm,患手恢复了捏夹,钩提及抓握等基本功能。结论 多指节段性毁损性离断进行缩短再植对恢复手的功能有益。     

断指再植成活1周指坏死的原因及临床分析

目的总结分析断指再植成活1周再植指体坏死的原因及教训，以提高断指再植的成活率。方法14例再植坏死指中5例行坏死指解脱术，9例行腹部管状皮瓣修复术。结果5例坏死指解脱术后2周切口拆线，甲级愈合；9例皮管修复术后5周断蒂，甲级愈合，保留了伤指的功能长度，随访3～6个月，近指问关节活动良好。结论对于创伤严重的断指再植术，应严格掌握手术指征，再植术中尽可能高质量吻合动脉、静脉，在超敏期内避免不良刺激，以免导致血管顽固性痉挛，术后1周认真观察血运，及时发现及时处理并发症。当出现再植指体坏死后，尽快行腹部管状皮瓣修复，以保留伤指的功能长度。     

趾节移植桥接再植指节缺损性断指

目的:研究手指节段缺损断指的再植方法,使再植后的手指长度、外形及功能更接近健指。方法:近侧指间关节毁损,远侧指间关节完整的断指,应用含有近侧趾间关节的节段性足趾移植完成桥接再植。结果:再植15例17指全部成活。术后随访7～28个月,一期修复后的患指长度、外形近似健指,两点辨别觉为5～15mm;11指经功能锻炼后指间关节主动活动度达屈50～70°,伸0°,6指屈曲小于40°,经二次手术肌腱松解后屈曲50～70°,伸0°。结论:节段性足趾组织移植与断指再植融合在一起,是治疗手指节段缺损的有效再植方法。     

断指再植的系统性功能康复

随着断指再植理论研究的深入和手术技术的提高,断指再植的评价标准已从早期单纯追求成活率转到断指的功能康复。恢复手指功能的关键,除了术中良好的骨与关节保护及固定,满意的神经肌腱修复外,术后进行合理和长期的康     

经关节平面离断的断指再植

断指再植时通常要短缩指骨 ,如是经关节平面的断指势必造成指关节的破坏 ,严重影响再植手术的关节功能。 1993年以来 ,我们选择经关节平面离断的断指 87指 ,行保留指关节的断指再植 ,取得了良好的效果。一、资料与方法　　 1.一般资料 :本组共 86例 87指 ,男 61例 62指 ,女 2 5例 2 5指 ;年龄 16～ 5 8岁 ,平均 3 6岁。离断关节平面 :掌指关节 7指 ,近侧指间关节 63指 ,远侧指间关节 17指。致伤原因 :剪板机离断伤 3 2指 ,旋转撕脱伤 2 7指 ,挤压撕脱伤 19指 ,刀具切割伤 9指。本组中 ,采用血管移植或邻指动脉转位修复 45指 ,采用邻指带指动…     

三角钢丝固定法在近指间关节周围断指再植中的应用

目的 评价在近指间关节周围断指再植时采用三角钢丝内固定法的临床疗效.方法　13例(19指)近指间关节周围的断指,其中中节基底13指,近节远端6指,断指再植时采用三角钢丝内固定法重建骨支架.结果　术后平均7周达骨愈合,近指间关节活动范围5°～84°.参照中华医学会手外科学会上肢部分功能试用标准进行评定,本组中优15指,良3指,差1指,优良率为94.7％.结论　在近指间关节周围断指再植时,采用三角钢丝法进行内固定,操作简便,有效固定的同时可允许早期开展关节功能训练,恢复良好的关节功能,临床效果满意.     

儿童小指旋转撕脱性断指再植

1997年 2月～ 1999年 8月 ,我们对 7例儿童小指旋转撕脱性断指进行再植 ,取得了比较满意的疗效。1　资料与方法1. 1　一般资料本组共 7例 ,男性 3例 ,女性 4例 ;年龄 7～ 13岁 ,平均 10岁。致伤原因 :机器皮带轮伤 4指 ,摩托车链条伤 3指 ,均为单指完全离断。受伤平面 :中节 4指 ,近节 3指。1. 2　手术方法(1)骨、关节修复 :7个手指骨缩短 0 5ｃｍ～ 0 8ｃｍ ,重建骨支架采用纵行克氏针或交叉克氏针固定 ,其中远侧指间关节融合 2指 (2 )肌腱修复 :屈肌腱缝合用ｋｅｓｓｌｅｒ法 ,伸肌腱用褥式法。其中环指浅屈肌腱转位修复指深屈肌腱 3指 …     

多指再植与功能恢复的关系

目的 探讨多指再植与功能恢复的关系。方法 对1980年以来,共收治断指再植成活在3个手指以上的22个病例进行随访,内容包括：再植手指的关节活动范围、感觉恢复程度、血液循环状况、外观及日常生活共5个方面对再植手指功能疗效评定。结果 22例102个再植手指中,89个手指功能疗效评定为优良：13个手指评定为差和劣,其主要原因为关节强直8例,3例为手指萎缩并缺乏感觉,2例再植手指有旋转畸形伴有神经瘤形成。结论 多指再植属特殊断指再植,其功能恢复有赖于损伤关节面完整性修复,解剖性一期缝接神经、肌腱;而术后阶段性、指导性、持续性、康复性训练,为再植手指获得理想功能的必备手段。     

足部带关节的复合组织瓣移植桥接修复拇、手指断指

目的 报道足部带关节的复合组织瓣移植桥接拇、手指断指的手术方法和临床疗效.方法 对10例拇、手指完全离断伴有近端指体缺损者,采用游离足部带关节的复合组织瓣桥接再植拇、手指进行修复.4例拇指离断者,采用带足第二跖趾关节、近侧趾间关节的复合组织瓣进行桥接修复3例,1例采用带足第二跖趾关节的复合组织瓣桥接修复,足部供区采用第二跖骨远端截骨截趾、足背游离皮片植皮术;6例手指离断者,采用带足近侧趾间关节的复合组织瓣进行桥接修复,足部供区采用足跖趾关节截趾术. 结果 术后10例复合组织瓣及再植拇、手指均顺利成活,手部伤口均一期愈合,足部供区除1例愈合不佳,经多次换药后愈合外,其余植皮及截趾区均一期愈合.10例患者获随访6 ～ 28个月,平均随访9个月.4例拇指再植者,掌指关节伸-10°～0°,屈曲达20°～50°,3例可以完成与2 ～5指对指,1例可以完成与示、中指对指,4例可以完成桡侧外展.6例手指再植者,移植的近侧指间关节伸-10°～0°,屈曲30°～90°,平均50°.感觉恢复1例达S4,2例S3+,5例S3,2例为S2.移植骨关节均愈合(骨性愈合时间为6～ 16周),未出现骨不连及再骨折.足部供区行走功能无明显影响.按照中华医学会断指再植评定标准评定,属优1例,良8例,差1例,优良率90％. 结论 采用游离足部带关节的复合组织瓣桥接再植拇、手指的方法,不仅可以最大限度的恢复再植指的外形,还可以获得部分手指功能,满足患者日常生活的需要.     

冲压伤性断指再植

随着显微外科技术的提高 ,断指再植的成活率已达 90 %左右 ,但由于冲压伤性断指在受伤时受到严重挤压 ,组织细胞和微循环遭到破坏 ,再植成活率较低。再植指成活后也多发生蒌缩或伴严重的肌腱粘连 ,功能恢复较差。我们对近 3年来 ,得到随访的 7例 15指冲压伤性断指再植进行了总结 ,功能恢复尚满意。一、资料与方法1.一般资料 :本组共 7例 17指 ,男 4例 ,女 3例 ;年龄 19～3 8岁 ,平均 2 7岁。损伤原因 :7例均系被压砖机或压瓦冲压机致伤。 17个断指中再植 15指 ,其中拇指 4个、示指 5个、中指 3个、环指 2个、小指 1个。 8指离断 1例 ,2指离…     

静脉移植和吻合掌侧静脉在不同平面末节断指再植中的应用

目的 探讨不同平面末节断指的再植方法.方法 2004-2007年,对63例71指末节断指,按损伤部位分为4区,采用静脉移植和吻合掌侧静脉的方法进行再植.结果 术后71指存活70指.随访时间为3个月至3年,再植手指饱满,手指长度正常,指甲外观满意.再植指两点分辨觉平均为6.5 mm,除Ⅳ区关节融合者外,其余拇指指间关节与远侧指问关节活动度平均为69°.结论 对末节断指的处理,为保留手指长度和指甲,血管移植修复是必要的,尤其是Ⅱ区和Ⅲ区,同时行掌侧静脉吻合对末节再植的成功至关重要.     

青少年及儿童末节压砸断指再植的临床特点

目的探讨青少年及儿童末节不同节段压砸断指再植方法的选择及临床疗效。方法2006年2月～2010年11月,对85例134指,年龄1～25岁的患（儿）者,因压砸致不同离断节段的末节断指．按照Ishikawa末节断指分区的血管特点,显微镜下行断指再植术。结果本组134指成活127指．成活率94．7％。术后随访4个月～3年,其中3指Ⅳ区断指因未成年骨骺未闭合,骨骺组织损伤较重．发育稍侧偏畸形、短小;4指甲根部损伤指甲不平整,其余再植指指甲、指腹外形良好。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63指,良55指,差9指;优良率达92．9％。结论针对青少年及儿童末节断指的不同离断节段的压砸伤,只要熟练掌握末节断指不同区域的血管特点,选择相应的再植方法．细心清创和精确吻合血管．就能提高再植成活率．降低残指率．从而恢复指体良好的外观及功能．     

Sensory recovery following digital replantation

The recovery of sensibility following digital replantation is essential in the restoration of hand function. We reviewed 12 series of digital replantations between 1977 and 1989. Three hundred sixty-seven fingers and 87 thumbs were successfully replanted. Mean age was 32.5 years. Mean follow-up was 33.5 months. Mean static two-point discrimination (S2PD) was 9.3 mm in clean thumbs vs. 12.1 mm in crush/avulsion thumb replantations. Mean S2PD was 8 mm in clean finger vs. 15 mm in crush/avulsion finger replantations. Overall mean S2PD was 11 mm in thumb and 12 mm in finger replantations. Sixty-one percent of replanted thumbs and 54% of replanted fingers regained useful S2PD (less than 15 mm or greater than or equal to S3 +). Factors that influenced digital sensibility following replantation included patient's age, level and mechanism of injury, digital blood flow, cold intolerance, and postoperative sensory reeducation. Recovery of sensibility in the replanted digit is comparable to simple nerve repair and to nerve grafting techniques. Further emphasis should be on elucidating the mechanism of cold intolerance, which was a significant complaint for most replanted digits. The universal practice of postoperative sensory reeducation will continue to improve digital sensibility following replantation.     

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.     

Evaluation outcome of replanted digits using the DASH score: review of 38 patients

The ultimate usefulness of replanted fingers is related to the adequacy of nerve, tendon and bone repair. Thirty-eight patients with successful replantation of the thumb, a single finger or after multiple digital amputations were followed up clinically. The subjective disability after finger replantation was evaluated by means of the DASH score, and the presence of cold intolerance was assessed. The subjective outcome of the achieved replantation reached an overall DASH score of 12.3. Patients after thumb replantation reached a score of 10.0, after a single finger replantation DASH 11.2 and after multiple finger amputations and replantation of at least one finger, DASH 16.1. Cold intolerance was subjectively found in 86.7% of all hands with replanted fingers without a correlation to the patients DASH scores. The patient's evaluation of their limb function after replanted digits by means of the DASH score, when combined with an objective external assessment, represents a valuable comparative tool.     

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.     

小儿末节压砸断指的临床特点及其血管处理

目的 探讨小儿末节压砸断指的临床特点、血管处理以及临床效果.方法 2005年1月至2009年8月,对28例38指11个月至11.5岁的小儿患者,按照Ishikawa末节断指分区的血管特点,在放大12～15倍手术显微镜视下进行断指再植术.结果 38指断指再植存活35指,坏死3指;成活率为92.1%.术后随访3个月至3年,除3指Ⅳ区断指因骨骺组织碾压伤、发育稍侧偏畸形外,其余患儿再植指指甲、指腹外形良好.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18指,良14指,差3指;优良率达91.4%.结论 小儿末节断指常为钝性损伤所致,压砸性断指多见,但只要熟练掌握小儿末节断指不同区域的血管特点,细心地清创和精确地吻合血管,仍可获得理想的成功率,小儿末节压砸断指应争取再植.     

特殊类型的断指再植

目的 报道特殊类型断指再植的方法及临床疗效。方法 对末节断指，1指多节离断断指，小儿断指，拇指撕脱性离断断指，双手多指离断断指及手指脱套性断指，根据不同的伤情采用不同的方法再植。结果 1532例上述断指再植存活1475例，存活率96．27％。外形及功能均较满意。结论 特殊类型手指离断伤，应严格掌握适应证，采用不同的方法施行再植，可获得较高的存活率，并能恢复较好的外形与功能。     

毁坏性断掌再植与功能重建

目的扩大毁坏性断掌再植的适应证，提高再植肢体功能恢复的效果。方法１９７９～１９９６年，根据伤情特点和重建手功能的要求，通过４种术式再植毁坏性断掌２３例：（１）２个断指移位再植于前臂残端；（２）２或３个断指移位再植于腕部；（３）５个手指全部移位再植于前臂残端；（４）示指移位再植于第１掌骨基底，修整第２掌骨形成虎口，其余３个手指分别再植于第３、４、５掌骨近端残端。结果２３例断掌再植后全部成活。５例经１年以上随访，综合评定手功能，平均失能值为３２％。结论许多严重毁坏的断掌，不仅可以再植成活，而且可以恢复较好的功能