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多指离断再植:临床结果的回顾性分析

Replantation for multiple digit amputations: A retrospective analysis of the clinical results.

作者信息

Kaneshiro Yasunori, Hidaka Noriaki, Yano Koichi, Sakanaka Hideki, Hyun Seungho, Takamatsu Kiyohito

机构信息

Hand and Microsurgery Center, Department of Orthopaedic surgery, Seikeikai Hospital, 590-0064 1-1-1, Minamiyasui-cho, Sakai city, Osaka, Japan.

Department of Orthopaedic surgery, Osaka City General Hospital, Japan.

出版信息

J Plast Reconstr Aesthet Surg. 2020 Nov;73(11):1995-2000. doi: 10.1016/j.bjps.2020.08.077. Epub 2020 Aug 28.

Abstract

PURPOSE

Replantation of multidigit amputations is difficult to perform due to severe damage to the digits, prolonged operative time, and ischemia. This study aimed to report the clinical results of multidigit replantation.

METHODS

A retrospective case series of 34 digits belonging to 12 consecutive patients who underwent multidigit replantation was conducted. Patients with injury in at least one or more amputated fingers proximal to the insertion of the flexor digitorum superficialis tendon were included. The mean follow-up duration was 18.1 months. The number of amputated digits, mechanism and zone of injury, survival rate, and clinical outcomes, including the range of motion, grip strength, and sensory recovery, at the final follow-up were reviewed and analyzed.

RESULTS

The mean number of amputated digits per patient was 2.8. Complete survival was achieved in 27 of 31 digits (87.1%). The mean final percentage of total active motion of injured digits was 47.0%, and the mean percentage of grip strength was 45.9% of the contralateral uninjured side. The comparison between patients with two and three amputated digits showed that there was no significant difference in both survival rates and functional outcomes.

CONCLUSIONS

The results showed that both the survival rates and functional outcomes of multidigit replantation were as good as those of single-digit replantation, and there was no significant difference for outcomes between patients with two and three amputated digits. These results suggested that all multidigit replantations should be performed regardless of the number of injured digits or amputation zones.

摘要

目的

多指离断再植因手指严重损伤、手术时间延长和缺血而难以实施。本研究旨在报告多指再植的临床结果。

方法

对连续12例接受多指再植患者的34个手指进行回顾性病例系列研究。纳入至少一个或多个离断手指在指浅屈肌腱附着点近端有损伤的患者。平均随访时间为18.1个月。回顾并分析最终随访时的离断手指数量、损伤机制和部位、存活率以及临床结果,包括活动范围、握力和感觉恢复情况。

结果

每位患者离断手指的平均数量为2.8个。31个手指中有27个(87.1%)完全存活。损伤手指总主动活动度的平均最终百分比为47.0%,握力平均百分比为对侧未受伤侧的45.9%。对有两个和三个离断手指的患者进行比较,结果显示存活率和功能结果均无显著差异。

结论

结果表明,多指再植的存活率和功能结果与单指再植一样好,有两个和三个离断手指的患者在结果上无显著差异。这些结果表明,无论受伤手指数量或离断部位如何,均应进行所有多指再植手术。

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