467例734个复杂性断指再植方法的选择与探讨

目的 探讨复杂性断指的分型及再植方法。方法 对467例734个复杂性断指依照伤情和术式结合的方法进行分类。对旋转性断指、脱套性断指、多节段性断指、伴皮肤神经血管缺损的断指、伴部分复合组织块缺损的断指、指尖离断及多指离断，分别采用不同的方法进行再植。结果 734个断指再植后存活721指，存活率达98．3％。术后随访到418例，共随访6～13个月。以最后1次随访结果为准，按中华医学会手外科学会断指再植功能评定试用标准评定，优284例，良95例，差39例，优良率达到90．7％。结论 复杂性断指的再植方法各异，正确判断伤情，选择最佳的手术方案是保证手术成功的重要前提。

Selection and investigation on replantation of 734 complicated amputated fingers in 467 cases

Objective To investigate the replantation methods and classification of complicated amputated fingers. Methods According to the injury mechanism and replantation methods, 734 complicated amputated fingers in 467 cases were classified. The proper surgical methods were chosen for replantation of rotated amputated finger, degloving amputated finger, multiple level finger amputation, finger amputation with defect of skin, nerve and vessel, finger amputation with partial composite tissue defect, finger tip amputation and multi-finger amputation. Results Of 734 complicated amputated fingers, 721 survived with the successful rate 98.3%. Regular follow-ups were done in 418 cases with a period of 6 to 13 months. According to the criteria for functional assessment of amputated finger issued by the Branch of Hand Surgery of Chinese Medicine Association, the last follow-up result as excellent in 284 cases, good in 95 cases and poor in 39 cases. The excellent and good rate was 90.7%. Conclusion Although there were different replantation procedures, it was utmost for successful surgical results to correctly estimate the injury degree and accordingly select the ideal operation method.