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.

Clinical analysis of 86 cases of replantation of amputated distal fingers

Objective To summrize the clinical results of replantatiion of 126 amputated distal fingers in 86 patients. Methods The amputated part was debridod under 16X high power magnification. Kirschner wires were uniformly used for bony fixation. Tendon repair was carried out next. Severed distal fingers were revasculafized with different kinds of operations according to type Ⅰ, type Ⅱ and type Ⅲ classification of the distal parts. Vein grafts were used in cases of venous or arterial gaps and continuous external bleeding was used in finger replantation with no venous anastomosis or venous congestion after the operation. Results All 114 replants survived uneventfully. The success rate of replantation was 90.5%. Follow up was carried out and showed that the successfully replanted fingers had good soft-tissue coverage and recovery of pain and touch sensation. Two-point discrimination of the finger pulp was 6 to 8 mm. The distal interphalangeal joint had normal flexion and extension. Conclusion The amputated distal fingers should be replanted whenever possible because it provides good appearance and maintains good joint motion. Vein grafts should be used in cases of venous or arterial gaps. Continuous external bleeding could be applied to enhance the survival rate of the replanted finger when no venous anastomosis was done or venous congestion occurred after the operation.