摘要
目的探讨创伤后上下肢离断29例再植手术的临床疗效及治疗体会。方法选取2004年1月-2014年11月收治的29例四肢离断伤患者,男性23例,女性6例;年龄23-47岁,平均35岁。其中电锯伤9例,砍伤6例,旋转撕脱伤3例,挤压碾轧伤11例;离断平面：上肢损伤9例,包括手掌部离断1例,前臂离断5例,上臂离断3例;下肢损伤19例,包括足部离断3例,踝部离断8例,小腿离断7例,双踝部完全离断1例。结果 29例共离断30肢,其中5例术后因血管危象行血管探查修复,2例发生感染导致再植肢体坏死,进而截肢;9例术后一次性成功;18例术后伤口部分皮肤坏死,行创面换药及二次植皮手术伤口愈合,成活率93.1%。按照断肢再植术后功能评定标准：上肢：Ⅰ级3例,Ⅱ级4例,Ⅲ级1例,1例再植失败;下肢：Ⅰ级9例,Ⅱ级9例,Ⅲ级1例,1例再植失败。结论综合考虑患者的全身情况,选择再植的适应证,合理全面的清创固定,及时正确的修复血管、神经、肌肉、肌腱等组织,术后合理的康复锻炼及功能锻炼,是提高断肢再植成活率及功能康复的重要因素。
Objective To discuss the clinical effects of limbs replantation and summarize the experience of surgical treatment. Methods A retrospective study（ from Jan. 2004 to Nov. 2014,29 patients with limb amputation were treated,23 males and 6 females,aged between 23-47 years old） enrolling the patients with limb amputations（ including 9 from electric saw injuries,6 from cut injuries,3 from rotation avulsions and 11 from crush injuries） was carried out. The amputated parts included 1 palm,5 forearms,3 upper arms,3 feet,3 ankles,7 legs,and both ankle complete amputation in one case. Results Among the 30 amputated limbs in 29 cases,5 cases underwent vascular repair caused by postoperative vascular crisis,2 cases underwent amputation due to necrosis caused by postoperative infection. Nine cases were successfully replanted in one-time,and 18 cases developing partial skin necrosis were all healed with a second skin grafting and dressing change. The overall survival rate was 93. 1%. According to the function evaluation standard after limb replantation,in the upper limbs,3 cases were classified as grade Ⅰ,4 cases as grade Ⅱ,1 case as grade Ⅲ,and 1 case failed replantation. In the lower limbs,9 cases were classified as grade Ⅰ,9 cases as grade Ⅱ,1 case as grade Ⅲ,and 1 case failed replantation. Conclusion Considering the patient＇s general condition,correct selection of indications for replantation,comprehensive debridement,timely and correct repair of blood vessels,nerves,muscles,tendon tissue,and reasonable rehabilitational exercise and functional exercise after operation are important for the improved survival rate of replantation and functional rehabilitation.
出处
《创伤外科杂志》
2016年第11期686-688,共3页
Journal of Traumatic Surgery
关键词
肢体
离断伤
再植术
limb
amputation injury
replantation
