断指再植术后坏死的相关因素分析

目的:探讨断指再植术后坏死的主要相关因素以采取有效的预防和控制措施。方法:对2013年1月至2013年12月收治的236例断指再植患者进行回顾性分析,共311指,其中男183例,女53例;年龄2～62岁,平均34.5岁,其中6岁以下6例,6岁以上230例。拇指51指,示指87指,中指78指,环指63指,小指32指。将再植术后坏死的40例40指作为观察组,其他再植存活病例作为对照组。比较两组年龄、性别、指别、吸烟史、受伤类型、断指缺血时间、离断平面、动静脉修复质量等方面的差异,分析引起再植术后坏死的相关因素。结果:手指完全离断再植236例共311指,术后坏死40指。完全离断指体再植术后坏死的主要相关影响因素包括:吸烟史、受伤类型、离断平面、动静脉修复情况(P<0.05).而与年龄、性别、指别、断指缺血时间无明显相关性(P>0.05).结论:吸烟史、受伤类型、离断平面及动静脉修复情况是完全离断指体再植术后坏死的独立预测因素,提示断指再植时应综合考虑患者基本情况、伤情,严格把握手术适应证,积极做好手术处理。

Risk factors of the failure in digit replantation

Objective:To explore the relative factors on the failure in digit replantation in order to take preventions to control the risk factors. Methods:From January 2013 to December 2013,236 consecutive patients(311 fingers) underwent digit replantation were collected to analyze retrospectively,involving 183 males and 53 females with an average age of 34.5 years old ranging from 2 to 62 years old(6 cases under 6 years old and 230 cases elder than 6 years old). There were 51 thumbs,87 index fingers,78 middle fingers,63 ring fings and 32 little thumbs. Forty cases(forty fings) who were failured as the observation group,the others as the control group. The factors of age,gender,finger,cause of injury,smoking history,ischemia duration,plane of division,condition of venous drainage and condition of arterial repair were assessed. Results:All 236 cases with 311 fingers were replanted,40 fingers were failured after operation. The relative factors on the failure in digit replantation included smoking history,cause of injury,plane of division,condition of venous drainage and condition of arterial repair (P<0.05). There were no significant correlation between the failure and age,gender,finger and ischemia duration (P>0.05). Conclusion:Smoking history,causes of injury,plane of division,condition of venous drainage and condition of arterial repair are risks of failure in digit replantation. Before choosing the type of operation,it should be think about the patient's general conditions,injury status,grasp firmly the operative indications and actively carry out surgical treatment.