摘要目的:探讨不缩短指骨显微外科断指再植术治疗末指离断的临床效果。方法:队列研究。抽取2020年2月至2023年7月于西安交通大学附属红会医院行断指再植术的末指离断患者79例(95指)，依据手术方式分为对照组(40例49指，行传统断指再植术)和研究组(39例46指，行不缩短指骨显微外科断指再植术)。比较两组断指恢复相关指标、再植断指功能评分、炎症因子及氧化应激指标、血液流变学指标、术后并发症发生情况。结果:术后，研究组两点辨别觉短于对照组，远端指尖活动度大于对照组，断指指甲长度长于对照组，再植断指成活率高于对照组( P<0.05)。研究组术后再植断指的外观、感觉、运动、工作能力评分高于对照组( P<0.05)。术后，两组血清C反应蛋白、肿瘤坏死因子-α、丙二醛水平高于术前，但研究组低于对照组( P<0.05)。术后，两组红细胞压积、血浆黏度、全血高切黏度低于术前，且研究组低于对照组( P<0.05)。研究组术后并发症总发生率(4.35%，2/46)低于对照组(20.41%，10/49)， P<0.05。 结论:不缩短指骨显微外科断指再植术治疗末指离断，再植断指术后恢复较好，功能评分较高，并发症较少。

abstractsObjective:To investigate the clinical effect of microsurgical replantation of amputated finger without shortening phalanges in the treatment of amputated ungual phalanges.Methods:A total of 79 patients with ungual phalanges amputation (95 severed fingers) who were treated by replantation of amputated finger in Honghui Hospital Affiliated to Xi’an Jiaotong University from February 2020 to July 2023 were selected for the cohort study. And they were divided into the control group (40 cases with 49 fingers, treated by traditional replantation of amputated finger) and the study group (39 cases with 46 fingers, treated by microsurgical replantation of amputated finger without shortening phalanges) according to surgical methods. The related indicators of severed finger recovery, functional score of replanted finger, inflammatory factors, oxidative stress indicators, hemorheology indicators, and incidence of postoperative complications were compared between the two groups.Results:Compared with the control group, the two-point discrimination in the study group was shorter, the range of motion of the distal fingertip was larger, the length of the severed fingernail was longer, and the survival rate of replanted finger was higher after operation ( P<0.05). The scores of appearance, sensation, movement, and work ability of the severed finger in the study group were higher than those in the control group after surgery ( P<0.05). After operation, the levels of serum C-reactive protein, tumor necrosis factor-α and malondialdehyde in the two groups were higher than those before operation, but these indexes in the study group were lower than those in the control group ( P<0.05). Compared with preoperative indexes, the hematocrit, plasma viscosity and whole blood viscosity at high shear rate of the two groups decreased after operation, and these indexes in the study group were lower than those in the control group ( P<0.05). The incidence of postoperative complications in the study group (4.35%, 2/46) was lower than that in the control group (20.41%, 10/49), P<0.05. Conclusions:Amputated ungual phalanges recover well after microsurgical replantation of amputated finger without shortening phalanges, with fewer complications. And the functional score of replanted finger is higher.