拇指近节撕脱性脱套完全离断再植的临床疗效
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摘要
目的探讨拇指近节撕脱性脱套完全离断再植手术的临床疗效。方法 2013年2月-2016年12月,对63例拇指近节撕脱性脱套完全离断患者的治疗进行回顾性分析。术后随访观察手指外观、指端感觉、手部功能恢复情况。结果术后成活60例,按照中华医学会手外科学会上肢部分断指再植功能评定试用标准评定疗效,优54例,良2例,可4例,优良率93.3%。结论拇指近节撕脱性脱套完全离断伤进行再植,成活后外观和功能良好。只要患者全身情况允许,远端离断指体尚完整,有可供吻接的血管和神经,并注意操作细节,即可将再植的绝对禁忌证转为相对禁忌证,并有较高的成活率。
Objective To discuss the clinical effect of the replantation on the complete degloved thumb amputation at the level of proximal segment. Methods From February 2013 to December 2016, we retrospectively analyzed the treatment of 63 cases with complete degloved amputation in the proximal segment of the thumb. The appearance of fingertip sensation and function recovery condition observed after surgery. Results Sixty cases survived, according to the evaluation criteria of the evaluation were standard of the upper extremity of standard the upper limb of the Chinese medical association, excellent in 54 cases, good in 2 cases, fair in 4 cases with the excellent and good rate of 93.3%. Conclusion As to the complete degloved thumb amputation at the level of proximal segment, the appearance and function after replantation is good, as long as the patients' general condition allows, the distal amputated thumb is complete, there are available blood vessels and nerves, pay attention to operation details, the absolute contraindications can be change to relative contraindications, and has a higher survival rate.
Objective To discuss the clinical effect of the replantation on the complete degloved thumb amputation at the level of proximal segment. Methods From February 2013 to December 2016, we retrospectively analyzed the treatment of 63 cases with complete degloved amputation in the proximal segment of the thumb. The appearance of fingertip sensation and function recovery condition observed after surgery. Results Sixty cases survived, according to the evaluation criteria of the evaluation were standard of the upper extremity of standard the upper limb of the Chinese medical association, excellent in 54 cases, good in 2 cases, fair in 4 cases with the excellent and good rate of 93.3%. Conclusion As to the complete degloved thumb amputation at the level of proximal segment, the appearance and function after replantation is good, as long as the patients' general condition allows, the distal amputated thumb is complete, there are available blood vessels and nerves, pay attention to operation details, the absolute contraindications can be change to relative contraindications, and has a higher survival rate.
引文
[1]张英军,朱吉武,付宝驰.大鱼际皮瓣修复拇指软组织缺损的临床体会[J].中国医药导报,2006,3(1):50.
[2]田建,芮永军,糜菁熠,等.微型外固定支架结合有限内固定治疗开放性粉碎性掌指骨骨折[J].中华手外科杂志,2013,29(1):4-6.
[3]江起庭,杨丽娜,程燕.第2足趾移植再造拇指后的感觉功能康复[J].中国临床康复,2003,7(12):1715.
[4]邓国权,邹锦考.应用手部岛状皮瓣修复拇指和手皮肤软组织缺损[J].中华显微外科杂志,2011,34(2):147-148.
[5]潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准[J].中华手外科杂志,2000,16(3):130-135.
[6]韦加宁.手外科手术图谱[M].北京:人民卫生出版社,2003.267.
[7]李瑞华,阙世廉,高艳新,等.拇指旋转撕脱离断的再植术式改进[J].中华骨科杂志,2012,32(12):1157-1160.
[8]潘金祥,顾加祥,刘宏君.手指撕脱性离断再植22例[J].实用手外科杂志,2015,29(4):406-408.
[9]杨波,宿晓雷,王华柱,等.56例拇指旋转撕脱离断再植回顾分析[J].实用手外科杂志,2017,31(2):180-182.
[10]王成琪,王剑利,张敬良,等.断手指分类与治疗方法的选择[J].中华显微外科杂志,2001,24(2):86-87.
[11]刘刚义.拇指旋转撕脱性离断再植方法探讨[J].实用手外科杂志,2009,23(2):79-81.
[12]范启申,王成琪.拇指旋转撕脱性离断再植方法[J].中华骨科杂志,1988,8(3):236.
[13]李金晟,吴红军,丛海波.前臂掌侧静脉移植在旋转撕脱性拇指离断再植术中的应用[J].实用手外科杂志,2007,21(3):181.
[14]刘宁富,杨绍安,李松建,等.断指再植的临床经验与体会[J].中华显微外科杂志,2003,26(2):138.
[15] Vlastou C,Earle AS.Avulsion injuries of the thumb[J].Hand Surg,1986,11(1):51.
[16]王加利,赵春霞.拇指旋转撕脱离断伤改良再植[J].中华手外科杂志,2012,28(6):373-374.
[17]崔永光,卢宏,李中锋,等.小型皮瓣在断指再植中的应用[J].中华显微外科杂志,2003,26(2):137-138.
[18]裴国献.脱套伤旋转撕脱性断指再植[J].中华显微外科杂志,1998,21(2):188-189.
[19]宋海涛,田万成,康庆林,等.断指再植的功能康复训练[J].中华创伤骨科杂志,2005,7(7):499-500.
[20]裴国献.断肢(指)再植康复观念的更新与对策[J].中华显微外科杂志,1995,18(3):169-172.
[21]刘宇舟,寿奎水,许亚军,等.套状撕脱性断指再植19例临床分析[J].中华手外科杂志,2011,27(3):187-188.
[22]张荣峰,张福田,孙新君,等.手指皮肤套状撕脱伤的再植治疗[J].中华手外科杂志,2015,31(4):311-312.
[2]田建,芮永军,糜菁熠,等.微型外固定支架结合有限内固定治疗开放性粉碎性掌指骨骨折[J].中华手外科杂志,2013,29(1):4-6.
[3]江起庭,杨丽娜,程燕.第2足趾移植再造拇指后的感觉功能康复[J].中国临床康复,2003,7(12):1715.
[4]邓国权,邹锦考.应用手部岛状皮瓣修复拇指和手皮肤软组织缺损[J].中华显微外科杂志,2011,34(2):147-148.
[5]潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准[J].中华手外科杂志,2000,16(3):130-135.
[6]韦加宁.手外科手术图谱[M].北京:人民卫生出版社,2003.267.
[7]李瑞华,阙世廉,高艳新,等.拇指旋转撕脱离断的再植术式改进[J].中华骨科杂志,2012,32(12):1157-1160.
[8]潘金祥,顾加祥,刘宏君.手指撕脱性离断再植22例[J].实用手外科杂志,2015,29(4):406-408.
[9]杨波,宿晓雷,王华柱,等.56例拇指旋转撕脱离断再植回顾分析[J].实用手外科杂志,2017,31(2):180-182.
[10]王成琪,王剑利,张敬良,等.断手指分类与治疗方法的选择[J].中华显微外科杂志,2001,24(2):86-87.
[11]刘刚义.拇指旋转撕脱性离断再植方法探讨[J].实用手外科杂志,2009,23(2):79-81.
[12]范启申,王成琪.拇指旋转撕脱性离断再植方法[J].中华骨科杂志,1988,8(3):236.
[13]李金晟,吴红军,丛海波.前臂掌侧静脉移植在旋转撕脱性拇指离断再植术中的应用[J].实用手外科杂志,2007,21(3):181.
[14]刘宁富,杨绍安,李松建,等.断指再植的临床经验与体会[J].中华显微外科杂志,2003,26(2):138.
[15] Vlastou C,Earle AS.Avulsion injuries of the thumb[J].Hand Surg,1986,11(1):51.
[16]王加利,赵春霞.拇指旋转撕脱离断伤改良再植[J].中华手外科杂志,2012,28(6):373-374.
[17]崔永光,卢宏,李中锋,等.小型皮瓣在断指再植中的应用[J].中华显微外科杂志,2003,26(2):137-138.
[18]裴国献.脱套伤旋转撕脱性断指再植[J].中华显微外科杂志,1998,21(2):188-189.
[19]宋海涛,田万成,康庆林,等.断指再植的功能康复训练[J].中华创伤骨科杂志,2005,7(7):499-500.
[20]裴国献.断肢(指)再植康复观念的更新与对策[J].中华显微外科杂志,1995,18(3):169-172.
[21]刘宇舟,寿奎水,许亚军,等.套状撕脱性断指再植19例临床分析[J].中华手外科杂志,2011,27(3):187-188.
[22]张荣峰,张福田,孙新君,等.手指皮肤套状撕脱伤的再植治疗[J].中华手外科杂志,2015,31(4):311-312.