热带沿海地区断指再植的临床研究

目的:观察热带沿海地区断指再植的临床治疗效果,探讨高温高湿高盐环境对断指再植术的影响。方法:2009年4月～2011年10月我科收治58例66指断指患者,断指再植术按清创、骨固定、修复肌腱、吻合血管、吻接神经顺序进行手术,患者术后2周开始进行功能锻炼,4周拔克氏针,同时对存活的断指进行功能评定。结果:所有患者均顺利完成手术,成活60指,坏死6指,成活率为90.9%。远节断指再植术成活率显著高于近节断指再植患者(P<0.05),中节断指再植与近节和远节断指再植成活率差异无统计学意义(P>0.05);离断时间≤断指成活率高于>6h组,其差异具有显著的统计学意义(P<0.05);断指采用低温保存成活率高于采用常温保存组,其差异具有显著的统计学意义(P<0.05);致伤原因的不同导致的断指成活率的差异不具有显著的统计学意义(P>0.05)。结论:热带沿海地区只要离断的手指条件许可,行断指再植术可取得良好的效果,彻底清除是断指存活的基础,对血管的精细吻合是断指存活的关键。

Replanlation of amputated finger in tropical coastal areas

Objective: To observe the influence of high temperature,high humidity and high salt on replanlation of amputated finger.Methods:A total of 58 cases with 66 amputated fingers admitted from April 2009 to October 2011 were selected.All had replanlation of amputated finger,including debridement,phalangeal set,tendon repair,vascular anastomosis and anastomosis of nerve.All patients had function exercise for 2 weeks after surgery.Kirschner wire was removed 4 weeks later.The function of survival amputated fingers was evaluated.Results:All patients had successful surgery,with 60 survival fingers,6 necrosis fingers,survival rate was 90.9%.Replanlation of amputated distal finger had significantly higher success rate than proximal fimgers(P<0.05),while the difference was not significant between middle fingers and distal fingers or proximal fingers(P>0.05).Figures with amputation time less than 6 h had significantly higher survival rate(P<0.05).Fingers with hypothermia perseverance had significant higher survival rate(P<0.05).The difference was not significant between amputated fingers due to different causes(P>0.05).Conclusions: Under appropriate condition,replanlation of amputated finger has satisfactory efficacy.Complete clearing and accurate vascular anastomosis are important.