CAJ | 학술논문

目的对拇指旋转撕脱离断再植术进行改良,并评估其近期临床疗效.方法 2007年1月至2009年7月,对拇指旋转撕脱离断患者7例实施再植术.男6例,女1例;年龄21～47岁,平均28.3岁.离断平面均为掌指关节水平.设计改良拇指旋转撕脱离断再植术,根据软组织条件短缩指骨后融合固定掌指关节;保留拇长屈、伸肌腱5～6 cm,将其断端与腱鞘或周围软组织缝合,拇指指间关节腱固定于屈曲15°位;取前臂掌侧静脉桥接桡动脉腕背支和拇尺掌侧固有动脉;背侧静脉直接吻合6例,静脉移植修复1例;双侧指固有神经均绕至掌骨背侧与桡神经浅支吻合.结果 7例再植拇指全部成活.1例于术后出现动脉危象,经手术和药物治疗后成活.术后随访3 ～24个月,再植拇指外形良好,对掌功能满意,指端感觉恢复S4级4例、S3级3例,两点辨别觉8～12 mm.结论前臂掌侧静脉桥接桡动脉腕背支和拇尺掌侧固有动脉重建拇指血供的方法操作简便,效果可靠,是治疗拇指旋转撕脱离断一种比较理想的方法.
목적 대무지선전시탈리단재식술진행개량,병평고기근기림상료효.방법 2007년1월지2009년7월,대무지선전시탈리단환자7례실시재식술.남6례,녀1례;년령21～47세,평균28.3세.리단평면균위장지관절수평.설계개량무지선전시탈리단재식술,근거연조직조건단축지골후융합고정장지관절;보류무장굴、신기건5～6 cm,장기단단여건초혹주위연조직봉합,무지지간관절건고정우굴곡15°위;취전비장측정맥교접뇨동맥완배지화무척장측고유동맥;배측정맥직접문합6례,정맥이식수복1례;쌍측지고유신경균요지장골배측여뇨신경천지문합.결과 7례재식무지전부성활.1례우술후출현동맥위상,경수술화약물치료후성활.술후수방3 ～24개월,재식무지외형량호,대장공능만의,지단감각회복S4급4례、S3급3례,량점변별각8～12 mm.결론 전비장측정맥교접뇨동맥완배지화무척장측고유동맥중건무지혈공적방법조작간편,효과가고,시치료무지선전시탈리단일충비교이상적방법.
Objective To introduce a modified replantation for thumb rotating avulsion amputation,and to evaluate its short term clinical outcome.Methods From January 2007 to July 2009,7 patients with thumb rotating avulsion amputation underwent replantation,including 6 males and 1 female,aged from 21 to 47 years (average,28.3 years).The amputation level of each thumb was metacarpophalangeal joint.During operation,fusion of metacarpophalangeal joint was performed according to injury degree of soft tissue; interphalangeal joint of the thumb was fixed in 15 degrees of flexion by sewing flexor pollicis longus muscle tendon and extensor pollicis longus muscle tendon to tendon sheath or soft tissue; the superficial vein harvested from ipsilateral forearm was used to bridge the dorsal carpal branch of radial artery and the ulnar palmacollateral artery of the thumb; direct anastomoses of dorsal veins were performed in 6 cases and venous transplantation in 1 case; and bilateral nerves were transferred to the back of the first metacarpal and anastomosed to the superficial branch of the radial nerve.Results All 7 replanted thumbs survived completely.Arterial crisis occurred in 1 case after operation,which was cured after operative and medication treatment.The follow-up period ranged from 3 to 24 months.The appearance and opposition function of replanted thumbs were satisfactory and the sensation of fingertip recovered to S4 in 4 cases and to S3 in 3 cases.The two point discrimination ranged from 8 to 12 mm.Conclusion Because bridging the dorsal carpal branch of radial artery and the ulnar palmar collateral artery of the thumb with a superficial vein harvested from ipsilateral forearm to reconstruct blood supply of the thumb is available and easy to be performed,this modified replantation is an ideal way to repair thumb rotating avulsion amputation.