Bieber E J, Wood M B, Cooney W P, Amadio P C
Department of Orthopedics, Mayo Clinic, Rochester, Minn. 55905.
J Hand Surg Am. 1987 Sep;12(5 Pt 1):786-90. doi: 10.1016/s0363-5023(87)80070-9.
During a 9-year period, 39 thumb avulsions required emergency replantation/revascularization at our institution. Amputation was complete in 28 (72%) cases and involved the dominant thumb in 31 (80%). Farm machinery was the source of injury in 33 (85%) cases. Follow-up ranged from 7 months to 6 years. Only 10 of the revascularization attempts (26%) were successful; the remaining attempts required amputation at the level of the injury. In two (18%) of the 11 partial amputations and in eight (29%) of the 28 complete amputations, revascularization was successful. In eight (31%) of the 26 thumbs in which vein grafts were used, revascularization was successful, while one of the other two successes involved a transfer of the radial digital artery of the index finger. In six of the ten successful revascularizations, nerve repair was attempted, but without further procedures, none of the six digits regained two-point discrimination of less than 1 cm.
在9年期间，我院有39例拇指撕脱伤需要紧急再植/血管重建。28例（72%）为完全离断，其中31例（80%）为优势拇指。33例（85%）的损伤源为农业机械。随访时间为7个月至6年。血管重建尝试中仅10例（26%）成功；其余尝试均需在损伤平面截肢。11例部分离断中有2例（18%）、28例完全离断中有8例（29%）血管重建成功。在使用静脉移植的26例拇指中有8例（31%）血管重建成功，另外两例成功案例中有1例涉及示指桡侧指动脉移位。在10例成功的血管重建中，有6例尝试进行了神经修复，但未进一步采取措施，这6例均未恢复两点辨别觉小于1厘米。
