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36例47指末节离断再植

REPLANTATION OF FINGERS IN CHILDREN

Eighty-three cases with 135 fingers of traumatic amputation of finger in children under 12 years old were treated by replantation. It was successful in Ⅰ29 digits, with the survival rate of 94.5 per cent. The author concluded that the most important points in finger replantation in children were: prevention of vascular spasm; protection of the bone epiphysis; careful repair of the vessels and nerves, and rehabilitation therapies.

腕上掌侧小静脉移植修复断肢再植中血管缺损

改良显微缝线吻合血管在断指再植中的临床应用

目的 总结改良显微缝线吻合血管在断指再植术中的优点及临床效果，为吻合微小血管提供一种新的显微缝线。 方法 2004 年4 月－ 2008 年4 月，应用改良显微缝线及传统显微缝线于157 例202 指断指再植术中吻合微小血管。男137 例，女20 例；年龄16 ～ 47 岁。机器压伤102 指，机器割伤39 指，电锯锯伤39 指，其他伤22 指。离断指别：拇指27 指，示指63 指，中指56 指，环指30 指，小指26 指。完全离断162 指，不完全离断40 指。受伤至手术时间30 ～ 200 min。随机分两组，改良组78 例105 指，应用改良显微缝线吻合血管342 条；传统组79 例97 指，应用传统显微缝线吻合血管325 条。 结果 单针吻合时间改良组（20.0 ± 2.5）s，传统组（28.0 ± 3.5）s；每一吻合口吻合时间改良组（12.5 ± 2.5）min，传统组（18.5 ± 4.3）min；吻合血管后至完全再通时间改良组（10.0 ± 2.6）min，传统组（12.0 ± 3.5）min；术后改良组出现血管危象致血管栓塞5 指（4.76%），传统组10 指（10.30%）。术后两组再植指体成活率改良组95.23%，传统组89.69%。末节再植成活率改良组95.34%，传统组89.47%；非末节再植成活率改良组95.16％，传统组89.83%。两组各指标比较差异均有统计学意义（P lt; 0.05）。患者均获随访，随访时间3 个月～ 2 年，再植指外观、功能恢复均满意。 结 论 应用改良显微缝线吻合微小血管具操作简便、可靠、缩短血管吻合时间及血管再通时间、提高断指再植术成功率等优点。

REPAIR OF DEFECTS AT BOTH ENDS OF BLOOD VESSELS IN EXTREMITIES WITH AGREAT DISPARITY IN DIAMETER BY VEIN TRANSPLANTATION

Objective To repair defects at both ends of theblood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities by phleboplasty of branched and double autogenous veins. Methods Three kinds of phleboplasties——funnel-shaped, raincape-shaped and transposed Y-shaped were designed. Experiments in fresh blood vessels in vitro were completed successfully. These methods were used clinically to repair injured external iliac veins, femoral arteries and veins, and popliteal arteries and veins, to replant severed fingers and to transplant toenail flaps on thumbs by harvesting autogenous great saphenous veins,small saphenous veins and forearm veins in 36 cases, including 35 cases in emergency operation and 1 case in selective operation.The length of grafted blood vessels ranged from 1.0 cm to 15.0 cm. Results The phleboplasties of funnel-shaped could enlarge the diameter by 1.0-1.25 times inanastomotic stomas. The phleboplasty of raincape-shaped could enlarge the diameter large enough to meet the demands for various blood vessels in extremities. The phleboplasty of transposed Y-shaped could provide large vein transplants. In36 grafted veins, 35 were in patency. The blood supply in extremities was normal.ConclusionThe funnel-shaped and raincape-shaped phleboplasties of branched veins can enlarge the anastomotic stomas of grafted veins. The transposed Y-shaped phleboplasty of double femoral veins is an ideal way to repair injured primaryblood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities.

COMPREHENSIVE REHABILITATION IN THE TREATMENT OF FUNCTIONAL IMPAIRMENT AFTER REPLANTATION OF MULTIPLE FIN GERS INJURY

The comprehensive rehabilitative treatment was used in 58 cases(194 finger)for functional impairment after eplantation. After the treatment the overall increase of flexion-extension range of motion was 30 to 130 degrees respectively. From the assessment of 10 items of daily activities, the patients could accomplish three-fourth of them. the average time taken for the treatment was 3 months with an excellent-good rate about 87.4%. Through the early comprehensive rehabilititive treatment patients could achieve better results.

AESTRACTS THE STUDY OF COMBINED DXM AND HAPARIN ON ULTRAMICROSTRUCTURE OF MDSCLE AND MICROCIRCULATION DURING DELATED REPLANTATION OF LIMB

rough the ultramicroscopic observation on muscle and microcirculation, Group A,where a largeamount of DXM combined with heporin was given svstematically and locally into the femoral artery of the severed limb before replantation, and in Group B only heporin was given, and Group C and D ascontrol.The results showed that if the hormone and heparin were administred in large dosage, it wasadvantageous to reduce the tissues from reperfusion injury during delayed replantation.

指侧方静脉在指尖离断再植中的应用

目的 介绍吻合指尖区侧方静脉重建回流行指尖离断再植的方法。 方法2009年3月－2011年12月，收治36例（42指）指尖离断患者。男20例（24指），女16例（18指）；年龄15～40岁，平均24.5岁。受伤原因：绞轧伤4例（4指），压砸伤6例（7指），电锯伤8例（8指），切割伤18例（23指）。离断指别：拇指3指，示指10指，中指15指，环指10指，小指4指。指尖分型：Ⅰ型19指，Ⅱ型5指，Ⅲ型11指，Ⅴ型7指。受伤至手术时间90 min～6 h，平均3.6 h。再植术中采用吻合侧方静脉重建回流，共吻合指侧方静脉80条，吻合动脉53条。 结果再植指尖均成活，无回流障碍发生，切口均Ⅰ期愈合。患者均获随访，随访时间6～24个月，平均14.5个月。指尖外形、功能恢复满意，指体无明显萎缩，39指指甲生长接近平整，3指指甲呈脊样生长。术后6个月根据1975年美国手外科学会推荐的手指总主动活动度（TAM）系统评定方法评定：优39指，良3指，优良率100%。 结论指尖离断再植中通过吻合侧方静脉可有效重建静脉回流。

吻合掌侧静脉且保留指甲的多指指尖离断再植

目的总结采用吻合掌侧静脉且保留指甲方法再植治疗多指指尖离断的疗效。 方法2006年10月－2011年12月，对8例17指指尖离断采用吻合掌侧静脉且保留指甲的方法进行再植。男5例，女3例；年龄11～45岁，平均26岁。致伤原因：冲压伤4例，电锯伤2例，切割伤2例。受伤指别：示、中、环指1例，示、中指4例，中、环指3例。受伤至手术时间2～6 h，平均3 h。 结果术后再植指全部成活，切口均Ⅰ期愈合。8例均获随访，随访时间7～24个月，平均16个月。患指外形及长度与健指相似，指甲平整，关节活动良好。触觉、温痛觉均恢复，两点辨别觉4～7 mm。末次随访时，根据中华医学会手外科学会断指再植功能评定标准评定：获优14指、良3指，优良率达100%。 结论多指指尖离断采用吻合掌侧静脉及保留指甲方法再植，不仅能提高断指成活率，还可恢复手指良好外观及功能。

REPLANTATION OF SEGMENTAL DESTRUCTIVE AMPUTATION OF MULTIPLE FINGERS

OBJECTIVE: To discuss the indication of replantation of destructive amputation of multiple fingers for improvement of the function of injured fingers. METHODS: From February 1996 to August 1999, 23 amputated fingers in 8 cases were shortened and replanted. The crushed digital bones were fixed by Kirschner wires, flexor tendons repaired by Kessler suture technique, and digital extensor tendons repaired by mattress suture. The arteries and veins were anastomosed in each finger at the ratio of 1 to 2 or 2 to 3. The defect of blood vessels was repaired by free graft of autologous veins in 5 fingers. All of the cases were followed up for 10 to 18 months, and clinical evaluation was performed. RESULTS: All replanted fingers survived in the 8 cases, with good sensation, two point discrimination of 6 to 12 mm, and satisfied function, such as pinching, grasping and hooking. The fingers were shortened for 2.6 cm in average, ranging from 2.2 cm to 4.0 cm. CONCLUSION: Multiple digits replantation by shortening fingers is beneficial to functional restoration of segmental destructive fingers.