复杂小腿离断伤再植与假肢治疗远期疗效分析

目的探讨复杂小腿离断伤再植与截肢的指征。方法25例复杂小腿离断伤患者，再植15例，截肢10例。再植病例在肢体存活后对术后出现的软组织缺损、骨缺损、肢体短缩等并发症以显微外科方法并肢体延长术进行修复。截肢病例在创面愈合后行小腿假肢治疗。结果术后随访3～10年（平均6．4年），再植15例中肢体存活11例，4例行延期截肢后行假肢治疗，再植成功的患肢有不同程度短缩，参照陈中伟的断肢再植下肢功能评定标准：Ⅰ级1例，Ⅱ级4例，Ⅲ级4例，Ⅳ级2例；假肢治疗14例患肢外观与正常无明显差别，12例可下地负重行走，2例轻度跛行。假肢治疗组患者满意度高于再植组。结论复杂小腿离断伤是否再植应结合毁损肢体严重程度评分、患肢的局部条件和预后功能情况综合考虑。

Long-term efficacy of replanlation vesus prosthetic replacement for complex severed lower legs

Objective To explore indications for replantation and amputation of complex severed lower legs. Methods Fifteen lower legs in 25 cases with complex severed lower limbs were replanted including four finally amputated again, and other 10 legs were amputated directly after trauma. Those with successful replantation were repaired with microsurgical technology and limb lengthening procedure for complications such as soft tissue defect, bone defect and limb shortening. The amputated cases were fitted with prosthetic limb after wound healing. Results All cases were followed-up for three to 10 years (6.4 years in average), and 11 lower legs were survived in 15 replanted cases and other four were finally amputated and fitted with prosthetic replacement. The limbs of those with successfully replantation shortened to varied extent, and one can be categorized as grade Ⅰ, four as grade Ⅱ, four as grade Ⅲ and two as grade Ⅳ, according to Chen's classification of function evaluation for replanted limbs. Appearance of prosthetic limbs in 14 cases had no significant difference from the normal, and 12 of them could walk with load and two had slight claudication. Those with prosthetic limbs were more satisfactory than those with replantation of the limbs. Conclusion Replantation for complex severed lower legs should be comprehensively considered based on mangled extremity severity score (MESS), their local condition and function prognosis.