Replantation of the digits amputated by motorcycle chain injury

Summary Over the past 5 years, 134 digits were replanted in 85 patients. In 9 patients — 10 digits (11%) — the causation of injury was a motorcycle chain. The significant incidence of this type of injury has prompted us to report the replantation results. Hopefully, this might be used to caution the public against cleaning the chain while it is in motion. The sites of amputation were 5 in Tamai's Zone I and 5 in Tamai's Zone II. All amputated parts were distal to the DIP joint. The digits were replanted with anastomosis of both the artery and the vein. Eight out of the 10 replanted digits survived to give a success rate of 80%. There was no statistical difference between this rate and that for all other replanted digits resulting from various causes in Zones I and II, i.e. 86%. The high success rate suggests that replantation of the chain-amputated digits should be recommended, and the apparently poor conditions of the crush injury are no contraindications for surgery.     

上臂高位断肢再植一例初步报告

目的报告一例上臂高位断肢再植的治疗结果。方法对1例左上臂高位断肢患者的病史,术后功能的恢复进行分析。结果本例患者术后再植肢体肿胀不明显,创面一期愈合。139d后,手指出现轻微的屈指运动,6个月后,左手出现触觉痛,8个月后,骨折线模糊,主动运动肩关节外展30°,前屈20°,肘关节屈75°,伸0,腕关节背伸0,掌屈15°,大小鱼际肌及手内在肌轻度萎缩,呈爪形手,被动屈曲时指尖能接近掌指关节,伸指受限,被动活动度达正常范围,腕关节近端痛觉,触压觉及温冷觉明显恢复,左手感觉尚未恢复。结论上臂高位离断再植的适应症是肢体完整,缺血时间短,神经非根性撕脱伤,且患者年轻,全身情况良好,应尽量给予再植。     

拇短屈肌重建拇对掌功能在断腕再植术后的应用

目的 探讨断腕再植术后的拇对掌功能重建的临床效果。方法 腕关节活动受限是断腕再植术后常见的并发症，也使晚期对掌功能重建受到制约。临床上，对8例断腕再植术后成活尺神经深支功能恢复较佳者，采用拇短屈肌移位重建拇对掌功能，弥补了不足。结果 术后随访1—6个月，疗效满意，达到最佳功能，能从事原有工作。结论 断腕再植后，对拇对掌功能丧失或恢复不足者，采用拇短屈肌移位重建拇对掌功能是一种较为理想的方法。     

断肢再植患者的应激反应及护理干预效果评价

目的探讨护理干预对断肢再植患者心理应激的影响。方法对78例断肢再植患者进行心理应激测定，并对其进行抗焦虑、抗抑郁、环境护理、放松技术、家庭支持、出院指导等护理干预。结果根据症状自评量表对入院3d及出院1d患者进行测定，断肢再植患者出院1d精神障碍明显低于入院3d（P〈0．01）。结论护理干预有利于断肢再植患者的心理调整和康复，并增强治疗护理效果。     

断指再植内固定方法的选择

断指再植选择哪种内固定方法最好．目前仍有争议．为了探讨这个问题，我们总结了１９８６年１２月至１９９３年１２月８３０例１０２４指的断指再植资料．对比了克氏针髓腔内固定、交叉克氏钟内固定两种方法再植后的总优良率，指骨延迟愈合及关节僵硬的发生率，未发现两者有显著差异，提示再植指的功能恢复情况与内固定方法并无明显的相关联系．根据断指再植手术特点，我们认为选择克氏针髓腔内固定最好，速度快，对创面损伤小，固定可靠。交又克氏针操作困难，钢板、钢丝等内固定对创面损伤大，需２次手术，故不适合于断指再植。     

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。     

173指手指皮肤套状撕脱伤临床疗效分析

目的 比较手指皮肤套状撕脱伤三种不同手术方法的疗效,为临床选择合理的治疗方案提供依据.方法 对2002年1月至2008年10月期间收治的173指手指皮肤套状撕脱伤患者,分别采用再植术(A组)、第二趾甲皮瓣修复术(B组)和腹部皮瓣修复术(C组),术后对手术方法进行疗效分析.结果 术后A组79指中存活72指,成活率为91.1％;B组79指中存活76指,成活率为96.2％;C组15指全部存活.术后随访3个月至2年,平均8个月.按照拇、手指再造功能评定试用标准进行评定:A组中优64指、良6指、可2指,优良率为97.2％;B组中优62指、良10指、可4指,优良率为94.7％;C组中优7指、良6指、可2指,优良率为86.7％.A组与B组的手功能恢复率明显高于C组,A组与B组之间差异无统计学意义.结论 治疗手指皮肤套状撕脱伤首选再植术,如远端血管无再植条件可选择第二趾甲皮瓣修复术,如上述2种术式都无条件实施再选用腹部皮瓣修复.     

尺侧指固有动脉与桡动脉腕背支桥接的断拇再植

目的:介绍一种治疗近端动脉严重损伤的拇指离断再植术的方法,并评价其疗效。方法:2007年2月至2009年3月,采用前臂掌侧静脉移植,桥接鼻咽窝处桡动脉腕背支与尺侧指固有动脉的远侧断端,治疗13例近端动脉严重损伤的拇指离断。男11例,女2例;年龄16～50岁,平均34.5岁。左侧7例,右侧6例。完全离断8例,不全离断5例。急诊再植10例,按常规步骤再植术后动脉危象探查修复3例。结果:13例拇指全部成活。所有患者获得随访,时间8～17个月,平均11个月。再植拇指外形满意,根据中华医学会手外科学会断指再植功能评定试用标准:优9指,良3指,差1指。指腹两点辨别觉58mm,平均6.5mm。结论:静脉移植桥接鼻咽窝桡动脉腕背支与尺侧指固有动脉远端的方法修复拇指动脉,行复杂拇指离断再植,手术体位舒适,不影响手部血供,扩大了再植适应证,提高了再植成功率。     

Microsurgery in the urgent and emergent management of the hand

Appropriate use of microsurgical techniques in the emergency management of injured hands increases the salvage rate of complex upper limb injuries. Over time, the indications for replantation, both major and minor, have expanded and techniques refined to get better functional outcomes. The wide choice of free flaps available has made primary reconstruction possible to obtain a good functional and aesthetic outcome. The benefits microsurgery offers in the emergent management of the injured hand are now firmly established. The challenge is to create and maintain centers which can provide around-the-clock, high quality microsurgery services. The issues of adequate training opportunities, obtaining adequate work load to maintain high skill levels, attracting talent into the field are the challenges faced in maintaining high levels of service. In the developing countries, in addition to these issues, increasing the awareness of the potential of microsurgical services among the medical personal and the public has to be addressed.     

臂丛神经联合阻滞与单纯肌间沟阻滞在手部断指再植手术中的效果对比

目的比较手部断指行再植手术采用肌间沟联合腋路臂丛神经实施阻滞同单纯实施肌间沟阻滞的临床效果。方法 90例行断指再植术患者随机分为A、B、C三组,A组(30例)实施肌间沟臂丛神经阻滞,B组(30例)实施腋路臂丛神经阻滞,C组(30例)实施肌间沟联合腋路臂丛神经阻滞。对患者的感觉阻滞情况及麻醉效果进行评价。结果 C组感觉阻滞起效时间为3.44±1.36min,明显短于A组(3.82±1.91min)和B组(5.25±1.52min)(P<0.05)。C组麻醉效果为100%,明显优于A组的90.0%和B组的93.3%(P<0.05)。结论断指再植术采用肌间沟联合腋路臂丛神经实施阻滞,阻滞和麻醉效果显著,值得推广应用。