Gorsche T S, Wood M B
Department of Orthopedics, Mayo Clinic, Rochester, MN 55905.
J Hand Surg Am. 1988 May;13(3):423-7. doi: 10.1016/s0363-5023(88)80023-6.
Our experience with 15 patients who had acute mutilating hand injuries from corn-picker machines is reviewed. Three injury patterns were defined. Type I involved severe injury to all digits of the hand, including the thumb; type II injuries involved amputation of all fingers, in whole or in part, but with sparing of the thumb; and type III injuries involved amputation of multiple fingers with sparing of the thumb and at least one other digit. Attempts at revascularization or at complex reconstruction of the injured digits in the period immediately after injury failed in all 15 patients. The most satisfactory results in patients with type I injuries were obtained by complex reconstructive procedures such as toe-to-hand transfer. Patients with type II injuries were best treated with construction of a mitten-type hand by various methods. Patients with type III injuries were best treated by amputation of the devascularized digits.
我们回顾了15例因玉米采摘机导致手部急性毁损性损伤患者的治疗经验。定义了三种损伤类型。I型损伤累及手部所有手指，包括拇指；II型损伤涉及全部或部分手指离断，但拇指保留；III型损伤涉及多个手指离断，拇指及至少另一个手指保留。在伤后即刻对损伤手指进行血管重建或复杂重建的尝试在所有15例患者中均告失败。I型损伤患者通过如足趾移植到手等复杂重建手术获得了最满意的结果。II型损伤患者采用各种方法构建连指手套样手治疗效果最佳。III型损伤患者采用离断失血管化手指治疗效果最佳。
