Saies A D, Urbaniak J R, Nunley J A, Taras J S, Goldner R D, Fitch R D
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina 27710.
J Bone Joint Surg Am. 1994 Dec;76(12):1766-76. doi: 10.2106/00004623-199412000-00003.
The rates of survival of the amputated part and the functional outcomes were studied retrospectively after seventy-three replantations and eighty-nine revascularizations in the upper extremity in 120 children. All operations were performed between January 1974 and December 1988 after partial and complete amputations at various levels. The ages of the patients ranged from three days to sixteen years. The average duration of follow-up was thirty-six months (range, fourteen months to seven years) for the patients who had had a replantation and thirty months (range, fourteen months to eight years) for the patients who had had a revascularization. The rate of survival of the amputated part was significantly higher (p < 0.0002) after revascularization (seventy-eight parts [88 per cent]) than after replantation (forty-six parts [63 per cent]). There was no association, for either group, between survival and the preoperative duration of ischemia, the level of the injury, the digit that had been injured, the number of arteries that had been repaired, or the use of venous grafts. The rate of survival after replantation of completely amputated parts was 72 per cent (twenty-eight of thirty-nine parts) when the amputation had resulted from a laceration injury and 53 per cent (eighteen of thirty-four parts) when the amputation had resulted from a crush or an avulsion injury. The rate of survival after revascularization of incompletely amputated parts was 100 per cent (all forty-five parts) when the injury had been the result of a laceration and 75 per cent (thirty-three of forty-four parts) when it had been the result of a crush or an avulsion. We did not find any relationship between the age of the patient and the rate of survival of the amputated part after revascularization; however, there was a significantly higher rate of survival (p , 0.02) after replantation in children who were less than nine years old (77 per cent [twenty-four of thirty-one parts]) compared with the rate in those who were nine to sixteen years old (52 per cent [twenty-two of forty-two parts]). The viability of the digit was in jeopardy after twenty-nine (40 per cent) of the seventy-three replantations and nineteen (21 per cent) of the eighty-nine revascularizations. Immediate reoperation resulted in the salvage of only two of the twenty-one replanted parts and six of the twelve revascularized parts that had a reoperation.(ABSTRACT TRUNCATED AT 400 WORDS)
对120名儿童上肢的73例再植和89例血管重建术后的断肢成活率及功能结果进行了回顾性研究。所有手术均在1974年1月至1988年12月期间进行，涉及不同部位的部分和完全离断伤。患者年龄从3天至16岁不等。接受再植手术患者的平均随访时间为36个月（范围14个月至7年），接受血管重建手术患者的平均随访时间为30个月（范围14个月至8年）。血管重建术后断肢成活率（78例[88%]）显著高于再植术后（46例[63%]）（p<0.0002）。对于两组而言，断肢存活与术前缺血持续时间、损伤平面、受伤手指、修复动脉数量或是否使用静脉移植物之间均无关联。因切割伤导致完全离断的断肢再植术后成活率为72%（39例中的28例），因挤压伤或撕脱伤导致完全离断的断肢再植术后成活率为53%（34例中的18例）。因切割伤导致不完全离断的断肢血管重建术后成活率为100%（45例全部存活），因挤压伤或撕脱伤导致不完全离断的断肢血管重建术后成活率为75%（44例中的33例）。我们未发现患者年龄与血管重建术后断肢成活率之间存在任何关联；然而，9岁以下儿童再植术后的成活率（77%[31例中的24例]）显著高于9至16岁儿童（52%[42例中的22例]）（p<0.02）。73例再植手术中有29例（40%）、89例血管重建手术中有19例（21%）术后断指存活受到威胁。对21例接受再植手术和12例接受血管重建手术且接受再次手术的病例而言，立即再次手术仅挽救了2例再植断肢和6例血管重建断肢。（摘要截断于400字）
