完全离断伤45例断指再植临床体会

目的：探讨完全离断伤45例断指再植的临床疗效及治疗体会。方法：自2007年12月至2009年10月收治完全离断伤手指45例52指,男29例,女16例,平均年龄22.5±3.5岁。切割伤17例,挤压伤13例,绞轧撕脱伤7例,压砸伤5例,其他3例。离断部位：末节16指,中节21指,近节15指。均急诊臂丛麻醉或气管插管全麻断指再植手术。结果：本组52指术后均获8个月～2.5年随访,成活49指,其中术后发生血管危象7指,动脉危象1指,静脉危象6指,经积极处理保指成功4指,坏死3指,成活率94.23%。再植手指外观良好,指腹两点辨别觉4.5～9mm,平均6±0.8mm。按断指再植功能评定标准评定,优17指,良26指,可3指,差3指,优良率87.76%。结论：完全离断伤手指断指再植经积极手术处理,术后合理用药及科学康复锻炼,疗效满意。

CLINICAL EXPERIENCE OF REPLANTATION OF 45 CASES OF COMPLETE SEPARATED FINGER

Objective：To study the clinical results and treatment experience of replantation of complete separated fingers.Methods：45 patients（52 fingers）were retrospectively analysed from December 2007 to October 2009.There were 29 males and 16 females,with average age of 22.5±3.5 years,including 17 cases of incised injury,13 cases of crushed injury,7 cases of twisted and avulsed injury,and so on,and separated position including 16 paratelum fingers,21 midplate fingers,15 approaching fingers.The replantation of amputated fingers were completed under brachial plexus anesthesia or tracheal intubation anesthesia in emergency.Results：52 fingers were followed up for 8 months to 2.5 years（average 18±2.2 months）,and 49 fingers survival.The vascular crisis happened on 7 fingers after operation,including 6 fingers venous crisis,one finger arterial crisis,and 4 fingers succeed in reservation,and 94.23% survival rate of replantation.The shape of replantation fingers were very good,and the two point discrimination of finger pulp were 4.5mm to 9.0mm（average 6±0.8mm）.According to functional evaluation criteria of replantation of amputated finger,17 fingers excellent,26 fingers good.The rate of excellency and goodness was 87.76%.Conclusions：Complete separated finger needs energetically operated treatment,rational use of drug and scientific rehabilitation exercise after operation;the result is satisfactory.