CAJ | 학술논문

目的：探讨显微外科技术治疗断掌再植的方法及临床疗效。方法：自2009年1月至2012年12月，采用显微外科技术急诊行断掌再植术治疗断掌患者45例，其中男37例，女8例；年龄13～45岁，平均25岁。术后采用存活率、中华医学会手外科学会上肢断肢再植功能评定试用标准对断掌再植功能恢复以及临床疗效进行评价。结果：通过再植手术治疗断掌患者45例，共成活39例共121指，成活率为87％；45例患者均获随访，时间3～15．5个月，平均11．5个月。中华医学会手外科学会上肢断肢再植功能评定试用标准总分80．27±1．93，其中优27例，良8例，差4例。结论：严谨把握断掌再植手术的适应证，掌握断掌复杂性的特点以及局部解剖关系，术中做到清创彻底，残存组织利用充分，并结合显微外科技术尽快、最大程度地吻合动静脉，重建血液循环并使损伤的神经得到合理的修复是断掌再植成功的关键。
목적：탐토현미외과기술치료단장재식적방법급림상료효。방법：자2009년1월지2012년12월，채용현미외과기술급진행단장재식술치료단장환자45례，기중남37례，녀8례；년령13～45세，평균25세。술후채용존활솔、중화의학회수외과학회상지단지재식공능평정시용표준대단장재식공능회복이급림상료효진행평개。결과：통과재식수술치료단장환자45례，공성활39례공121지，성활솔위87％；45례환자균획수방，시간3～15．5개월，평균11．5개월。중화의학회수외과학회상지단지재식공능평정시용표준총분80．27±1．93，기중우27례，량8례，차4례。결론：엄근파악단장재식수술적괄응증，장악단장복잡성적특점이급국부해부관계，술중주도청창철저，잔존조직이용충분，병결합현미외과기술진쾌、최대정도지문합동정맥，중건혈액순배병사손상적신경득도합리적수복시단장재식성공적관건。
Objective:To explore methods and clinical outcomes of microsurgical technique in treating patients with sev-ered palm. Methods:From January 2009 to December 2012,45 patients with severed palm were treated by replantation through microsurgical technique ,included 37 males and 8 females ,aged from 13 to 45 years old with an average of 25. Postop-erative survival rate and evaluation standard of upper limb replantation function posposed by Chinese Medical Association were applied for evaluate clinical outcomes after operation. Results:Forty five patients with severed plam were treated by replanta-tion. Thirty nine patients (121 fingers) were survived,and survival rate was 87%. All patients were followed up 3 to 15.5 months with an average of 11.5 months. According to evaluation standard of upper limb replantation function posposed by Chi-nese Medical Association,the total score was 80.27±1.93,and 27 cases got excellent results,8 good and 4 poor. Conclusion:The success of replantation of severed palm depends on grasping operation indication strictly ,knowing complexity and local anatomic relationship,debridement completely during operation,making full use of remaining organization,arteriovenostomy through microsurgical technique as early as possible ,constructing circulation and repairing injuried nerve rationally.