CAJ | 학술논문

目的探讨小儿末节压砸断指的临床特点、血管处理以及临床效果.方法 2005年1月至2009年8月,对28例38指11个月至11.5岁的小儿患者,按照Ishikawa末节断指分区的血管特点,在放大12～15倍手术显微镜视下进行断指再植术.结果 38指断指再植存活35指,坏死3指;成活率为92.1%.术后随访3个月至3年,除3指Ⅳ区断指因骨骺组织碾压伤、发育稍侧偏畸形外,其余患儿再植指指甲、指腹外形良好.按中华医学会手外科学会断指再植功能评定试用标准评定:优18指,良14指,差3指;优良率达91.4%.结论小儿末节断指常为钝性损伤所致,压砸性断指多见,但只要熟练掌握小儿末节断指不同区域的血管特点,细心地清创和精确地吻合血管,仍可获得理想的成功率,小儿末节压砸断指应争取再植.
목적 탐토소인말절압잡단지적림상특점、혈관처리이급림상효과.방법 2005년1월지2009년8월,대28례38지11개월지11.5세적소인환자,안조Ishikawa말절단지분구적혈관특점,재방대12～15배수술현미경시하진행단지재식술.결과 38지단지재식존활35지,배사3지;성활솔위92.1%.술후수방3개월지3년,제3지Ⅳ구단지인골후조직년압상、발육초측편기형외,기여환인재식지지갑、지복외형량호.안중화의학회수외과학회단지재식공능평정시용표준평정:우18지,량14지,차3지;우량솔체91.4%.결론 소인말절단지상위둔성손상소치,압잡성단지다견,단지요숙련장악소인말절단지불동구역적혈관특점,세심지청창화정학지문합혈관,잉가획득이상적성공솔,소인말절압잡단지응쟁취재식.
Objective To investigate the clinical features of crushed amputations at the distal fingers in children, summarize strategies for handling the vessels in replantation and assess its clinical outcomes. Methods From January 2005 to August 2009, 38 severed fingers in 28 patients of 11 months to 11.5 years old were replanted. The vessels were anastomosed under 12X to 15X magnification based on the vascular characteristics according to Ishikawa's classification. Results Tirty-five out of the 38 replanted fingers survived, while only 3 necrosed. The survival rate was 92.1%. Postoperative follow-up ranged from 3 months to 3 years. Satisfactory results in terms of the contours of finger nail and pulp, and finger length were achieved in all the survived cases except for mild lateral deviation deformity in three cases due to the crushing injury of epiphysis in zone Ⅳ. According to the functional evaluation criteria formulated by Chinese Hand Surgery Society, results were excellent in 18 cases, good in 14 cases, and poor in 3 cases. The overall excellent-good rate was 91.4%. Conclusion Blunt injury is the common cause of distal finger amputation in children, mostly manifested as crushed amputations. Satisfactory results can be obtained provided that the surgeon is familiar with the vascular anatomy of the distal finger, and that meticulous debridement and precise vascular anastomosis are done. Therefore, the crushed amputations at the distal fingers in children are also the candidates for replantation and should be replanted aggressively.