手指完全套脱离断后再植的术式改进探讨
A modified replantation technique for fingers completely amputated by degloving injuries
目的 对传统的手指完全套脱离断后再植术式进行改进,并评估其近期临床治疗效果.方法 自2010年4月至2015年9月,我们对16例手指完全套脱离断患者在小切口下实施断指再植术,并采用同指一侧指神经移植修复另一侧指神经,再通过端侧缝合修复神经供区侧指神经重建手指感觉.结果 术后16指再植存活14指,随访时间为5~12个月,平均8个月,再植指体外观、功能恢复满意,两点分辨觉为5~8mm.根据中华医学会手外科学会断指再植评定试用标准评定:优9指,良4指,中1指.结论 在小切口下对完全套脱离断手指进行再植,并采用同指一侧指神经移植修复另一侧指神经,联合端侧缝合的方法修复神经供区侧指神经重建手指感觉,是手指完全套脱离断伤再植的一种比较理想的方法.
更多Objective To modify the conventional replantation technique for degloving amputated fingers,and evaluate its short term clinical outcomes.Methods From April 2010 to September 2015,16 degloving amputated fingers were replanted.The degloving amputated fingers were replanted through a small incision.The digital nerve of the finger on one side was repaired by transplantation of the digital nerve from the other side,while the contralateral digital nerve was repaired by end-to-side neurorrhaphy to the grafted digital nerve for sensory restoration.Results Fourteen of the 16 replanted fingers survived.The patients were followup for 5 to 12 months,with an average of 8 months.The function and appearance of the replants were satisfactory.Two-point discrimination was 5 to 8 mm.According to the evaluation criteria for finger replantation and reconstruction issued by the Hand Surgery Society of the Chinese Medical Association,the results were excellent in 9 cases,good in 4 cases,and fair in 1 case.Conclusion Replanting the finger through a small incision while grafting the digital nerve on one side and end-to-side neurorrhaphy on the other side for sensory restoration is an ideal way to replant degloving amputated fingers.
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