CAJ | 학술논문

目的探讨拇、手指末节旋转撕脱离断伤术后血管危象及坏死的识别及处理,为临床提供参考.方法对10例12指拇、手指末节旋转撕脱离断再植的患者,术后3～4d出现血管危象及坏死,通过延长甲床渗血时间,指腹侧方小切口放血,加强换药和显微外科用药等方法积极处理.一般观察到2周左右,拆除缝线,去除末端指体黑痂,即可发现指体表面颜色红润.结果再植12指均存活,术后随访时间为6～36个月,平均26个月.所有患者对再植指外观及功能满意,指腹两点分辨觉达3.2～5.0 mm,平均4.2mm,感觉恢复至S3～S3+.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8指,良4指,优良率为100％.结论拇、手指末节旋转撕脱离断伤术后血管危象及假性坏死并不少见,正确的处理有助于提高手术的成功率,减少截指率.
목적 탐토무、수지말절선전시탈리단상술후혈관위상급배사적식별급처리,위림상제공삼고.방법 대10례12지무、수지말절선전시탈리단재식적환자,술후3～4d출현혈관위상급배사,통과연장갑상삼혈시간,지복측방소절구방혈,가강환약화현미외과용약등방법적겁처리.일반관찰도2주좌우,탁제봉선,거제말단지체흑가,즉가발현지체표면안색홍윤.결과 재식12지균존활,술후수방시간위6～36개월,평균26개월.소유환자대재식지외관급공능만의,지복량점분변각체3.2～5.0 mm,평균4.2mm,감각회복지S3～S3+.안중화의학회수외과학회단지재식공능평정시용표준평정:우8지,량4지,우량솔위100％.결론 무、수지말절선전시탈리단상술후혈관위상급가성배사병불소견,정학적처리유조우제고수술적성공솔,감소절지솔.
Objective To explore the differentiation and treatment of vascular crisis and necrosis after replantation of the distal fmger that was amputated at the distal interphalangeal joint with complex rotation avulsion injury.Methods Ten cases of 12 fingers and thumbs mutilated from distal to the nail base or from the distal interphalangeal joint were treated with replantation.Vascular crisis occurred 3 to 4 days post-replantation.Vein drainage was provided by nail removal or small lateral incision to allow bleeding from the nail bed or the incision.Dressing change and anticoagulants were applied.After 2 weeks observation the stitches were removed and the necrotic tissue peeled off to reveal a viable finger tip.Results All 12 replants survived.Postoperative followup period ranged from 6 to 36 months with an average of 26 months.All the patients were satisfied with the appearance and function of the replanted fingers.Static 2-point discrimination(S2PD)was 3.2 to 5.0 mm (mean,4.2 mm)at the finger pulp.Sensory recovery reached S3 to S3+.According to the criteria for function of reconstructed thumb and fingers issued by the Hand Surgery Society of the Chinese Medical Association the results were rated excellent in 8 fingers and good in 4 fingers,achieving 100％ satisfactory rate.Conclusion Pseudo-vascular crisis and necrosis after replantation of the distal interphalangeal joint amputated with complex rotation avulsion injury is common.Correct treatment can improve survival,achieve good functional and esthetical recovery and avoid unnecessary amputation.