中华手外科杂志
中華手外科雜誌
중화수외과잡지
CHINESE JOURNAL OF HAND SURGERY
2012年
1期
44-45
,共2页
王加宽%李俊%盛春勇%陈智博%肖夕凤
王加寬%李俊%盛春勇%陳智博%肖夕鳳
왕가관%리준%성춘용%진지박%초석봉
创伤和损伤%前臂%手%显微外科手术
創傷和損傷%前臂%手%顯微外科手術
창상화손상%전비%수%현미외과수술
Wounds and injuries%Forearm%Hand%Microsurgery
目的 介绍严重前臂及手部外伤的修复与功能重建的方法.方法 对26例严重前臂及手部外伤,采用显微外科方法进行修复与功能重建.软组织缺损面积4 cm×5 cm～ 20 cm×8 cm,均伴有不同程度的骨骼、肌腱、血管及神经的外露或缺损,其中患肢血液循环完全丧失15例,伴有大段血管缺损8例,伴有神经缺损5例.结果 术后随访时间为6个月至5年,平均20个月,26例肢体全部存活.根据中华医学会手外科学会上肢部分功能评定试用标准评定:优13例,良9例,可3例,差1例；优良率为84.6％.结论 严重前臂及手部外伤是一种复杂而严重的损伤,正确评估损伤肢体的血液循环及软组织损伤程度和缺损的范围,确定缺损且要重建的结构,合理设计手术方案,采用显微外科方法修复,先恢复患肢血液循环,同期或分期进行功能重建,以挽救一些符合截肢指征的肢体.
目的 介紹嚴重前臂及手部外傷的脩複與功能重建的方法.方法 對26例嚴重前臂及手部外傷,採用顯微外科方法進行脩複與功能重建.軟組織缺損麵積4 cm×5 cm～ 20 cm×8 cm,均伴有不同程度的骨骼、肌腱、血管及神經的外露或缺損,其中患肢血液循環完全喪失15例,伴有大段血管缺損8例,伴有神經缺損5例.結果 術後隨訪時間為6箇月至5年,平均20箇月,26例肢體全部存活.根據中華醫學會手外科學會上肢部分功能評定試用標準評定:優13例,良9例,可3例,差1例；優良率為84.6％.結論 嚴重前臂及手部外傷是一種複雜而嚴重的損傷,正確評估損傷肢體的血液循環及軟組織損傷程度和缺損的範圍,確定缺損且要重建的結構,閤理設計手術方案,採用顯微外科方法脩複,先恢複患肢血液循環,同期或分期進行功能重建,以輓救一些符閤截肢指徵的肢體.
목적 개소엄중전비급수부외상적수복여공능중건적방법.방법 대26례엄중전비급수부외상,채용현미외과방법진행수복여공능중건.연조직결손면적4 cm×5 cm～ 20 cm×8 cm,균반유불동정도적골격、기건、혈관급신경적외로혹결손,기중환지혈액순배완전상실15례,반유대단혈관결손8례,반유신경결손5례.결과 술후수방시간위6개월지5년,평균20개월,26례지체전부존활.근거중화의학회수외과학회상지부분공능평정시용표준평정:우13례,량9례,가3례,차1례；우량솔위84.6％.결론 엄중전비급수부외상시일충복잡이엄중적손상,정학평고손상지체적혈액순배급연조직손상정도화결손적범위,학정결손차요중건적결구,합리설계수술방안,채용현미외과방법수복,선회복환지혈액순배,동기혹분기진행공능중건,이만구일사부합절지지정적지체.
Objective To introduce the methods for repairing severe forearm and hand injuries and functional reconstruction.Methods Microsurgical techniques and procedures were employed to treat 26 cases with severe forearm and hand injuries.The affected areas of tissues were 4 cm × 5 cm to 20 cm × 8 cm,where bones,tendons,blood vessels and nerves were either exposed or missing to different degrees.Among 26 cases,there were 15 cases with complete loss of blood supply,8 cases with long defect of blood vessels and 5 cases with defect of nerves.Results Postoperative follow-up ranged from 6 months to 5 years,with an average of 20months.All 26 repaired and reconstructed forearm or hand survived.According to the upper llmb functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association,the outcomes were rated as excellent in 13 cases,good in 9 cases,fair in 3 cases and poor in 1 case,achieving an overall 84.6％satisfactory rate.Conclusion Severe injury and defect of the forearm and hand is complex.Accurate assessment of the blood circulation and the extent and severity of tissue injury,and designing surgical procedures accordingly are critical.Restoration of the blood supply using microsurgical techniques and simultaneous or staged functional reconstruction can salvage some limbs that would otherwise be amputated.
