改良断腕再植与普通断腕再植的疗效比较

摘要

Objective To compare the clinical effects of modified amputation replantation and conventional amputation replantation. Methods From March 2008 to June 2017, 42 cases of wrist amputation were treated, 22 cases were replanted with modified amputation and 20 cases were replanted with conventional amputation. The clinical complications such as limb and skin tissue necrosis, vascular crisis, wound infection and functional recovery were analyzed. Results The following-up was 12～60 months (mean 36 months). There were 19 cases of primary healing, 3 cases of complications, 2 case of vascular crisis, 1 case of skin necrosis and wound infection in 22 cases of modified amputated wrist replantation. Among the 20 cases of common carpal replantation, 11 cases had stage I healing, 9 cases had complications, 2 cases had carpal necrosis, 4 cases had vascular crisis, 2 cases had skin necrosis and wound infection. The degree of muscle contracture in wrist and palm of modified wrist replantation was slight. The movement of the knuckles and the sensation of the fingers recovered better than those of the common amputation wrist replantation. The results were as follows: 16 cases were excellent, 3 cases were good, 2 cases were fair, 1 case was poor, according to the evaluation criteria of upper limb replantation function of the Chinese Medical Association. The excellent rate was 86.36％. The common amputation replantation was excellent in 8 cases, good in 3 cases, fair in 5 cases, poor in 4 cases, the excellent rate was 55％. Conclusion The excellent rate and the lower incidence of complications in the treatment of amputated wrist replantation are superior to those of the common amputated wrist replantation.%目的 比较改良断腕再植与普通断腕再植的临床疗效.方法 2008年3月-2017年6月,收治腕部离断42例,根据已完成的手术分为两组,其中改良断腕再植组22例和普通断腕再植组20例,术后对肢体及皮肤组织坏死、血管危象、伤口感染、功能恢复等并发症发生情况进行临床疗效分析.结果 术后42例断腕全部成活,随访12～60个月,平均36个月,改良断腕再植组22例中,19例I期愈合,3例出现并发症,2例出现血管危象,1例出现皮肤坏死及伤口感染;普通断腕再植组20例中,11例I期愈合,9例出现并发症,2例出现腕部坏死,6例出现血管危象,2例出现皮肤坏死及伤口感染.改良断腕再植组腕部及手掌部肌肉组织挛缩程度轻,各指关节活动及各指的感觉恢复均好于普通断腕再植组,按照中华医学会手外科学会上肢再植功能评定试用准进行评定:优16例,良3例,可2例,差1例,优良率86.36％;普通断腕再植组,优8例,良3例,可5例,差4例,优良率55％.结论 治疗断腕再植,改良断腕再植优良率和并发症发生率均优于普通断腕再植.