拇指末节旋转撕脱性离断再植方法探讨

目的探讨拇指末节旋转撕脱性完全离断再植的方法及临床疗效。方法对39例拇指末节旋转撕脱性完全离断患者，采用缩短骨骼融合指间关节的方法进行再植，使一侧指固有动脉在无张力下直接吻合（3例采用静脉移植），吻合1-2条指静脉及指神经或行动静脉分流重建静脉回流，不能吻合静脉者甲床滴血及指尖侧切滴血。结果39例患指再植术后34例成活，5例坏死，成活率87.2％，成活患指恢复了良好外观、功能、感觉。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29例，良4例，差1例。结论该手术方式是一种治疗拇指末节旋转撕脱性完全离断再植简单有效的手术方法，成活率高，功能恢复满意，可选择性地应用于拇指末节旋转撕脱性离断患者。

An Alternative Technique for Replantation of Avulsed Thumb Amputation at the Level of the Interphalangeal Joint or the Distal Phalanx

Objective To introduce an alternative technique for replantation of avulsed thumb amputation at the level of the interphalangeal joint or the distal phalanx. Methods 39 cases of avulsed thumb amputation at the level of the interphalangeal joint or the distal phalanx were replanted as follows：shorten the bone and arthrodesis the inter-phalangeal joint so that the digital artery and nerve can be anastomosed directly. We anastomed 1-2 digital veins or arterialvenous shunt for outflow. And removed the nail and incised in the fingertip for who have no useful veins, Resuits 34 of 39 thumbs （87.2%） were survived. The appearance ,function and sensitive were found to be satisfactory. According to the critera for function assement of amputated finger issued hy the Branch of Hand Surgery of Chinese. Medicine Association：excellent in 29,good in 4,poor in 1. Conclusion It is an effective and easy technique for replan ration of avulsed thumb amputation at the level of the interphalangeal joint or the distal phalanx. The survival rate and clinical outcome are reliability.