多指离断再植的探讨

目的 探讨多指离断再植手术中各阶段处理方法，提高各种断指再植的成功率。方法 手指末节、指尖部的断指再植，吻合1条动脉及静脉或者吻合1条动态加拔指甲、小切口放血处理，手指中节断指再植吻合动，静脉比例为1：1，手指近节的距离断再植吻合动、静脉比列1：2或者2：2。如有血管缺损，行浅静脉移植桥接或者邻指动脉移植修复。临床再植58例，142指。结果 再植58例142指中成活129指，成活率90.8%。术后经3个月-3年随访到46例113指。按断指再植评定标准评定，其中优53指，良44指，可14指，差7指，总优良率85.8%.结论 多指离断再植手术时间长,技术要求高。术中高质量的血管吻合及对血管缺损的正确处理，术后血管危象的防治是提高多手指离断再植成功的关键。加强功能锻炼是再植手指功能恢复的重要环节。

Treatment outcome of multiple digital replantation

Objective To summarize the methods of multiple digital replantation in different stages and improve the survival rate of replanted digits Methods In the procedure of replantation for fingertip one artery and one vein were anastomosoed, or one atrery was anastomosed accompanied with pulling out the nail and cutting small incision For middle of digit one artery and one vein were anastomosed For the proximal digit the ratio of anastomose for arteries and veins was 1 to 2 or 2 to 2 Superficial vein from arm or artery from the other finger was used if defection of vessel occur Results One hundred and twenty nine digits survived among the 142 replanted digits from 58 cases (survival rate was 90 8%),among which 113 fingers from 46 cases were subjected to following up form 3 months to 3 years, the rate of excellent and good was 85 8% Conclusion It takes more time and higher techniques to replant multiple digits To improve the survival rate, it is important to anastomose vessel excellently, deal with the defection of vessel correctly, and treat postoperative vessel crisis properly In addition, training exercise plays an important role in fnnctional recovery