Baker G L, Kleinert J M
Christine M. Kleinert Institute for Hand and Micro Surgery, Louisville, Ky.
Plast Reconstr Surg. 1994 Jul;94(1):139-45. doi: 10.1097/00006534-199407000-00015.
Thirty-three children under 34 months of age with 41 digits amputated over a 15-year period were reviewed. There were 3 primary amputations, 6 composite grafts, and 32 replantations. Twenty-one variables were evaluated for their influence on 4-week digit survival. The overall survival rate of 32 replanted digits was 69 percent. Favorable uncontrollable variables were clean-cut injury and body weight greater than 11 kg. Favorable controllable variables included more than one vein repaired, bone shortening, interosseous bone fixation, and vein grafting of arteries or veins. Forty-one percent of children required a blood transfusion. Children with trauma to more than one digit were most likely to be transfused (p < 0.05). The combination of prompt digit reperfusion after successful arterial repair and at least one successful venous anastomosis resulted in a 95 percent digit survival rate, significantly higher than the 0 percent survival of digits lacking one or the other of these features.
对15年间33名34个月以下儿童的41根断指进行了回顾性研究。其中有3例一期截肢、6例复合组织移植和32例再植。评估了21个变量对断指4周存活情况的影响。32例再植断指的总体存活率为69%。有利的不可控变量为锐器切割伤和体重超过11千克。有利的可控变量包括修复一根以上静脉、骨缩短、骨间固定以及动脉或静脉的静脉移植。41%的儿童需要输血。多指受伤的儿童最有可能接受输血（p<0.05）。成功进行动脉修复后迅速进行断指再灌注且至少有一次成功的静脉吻合，这两者相结合使断指存活率达到95%，显著高于缺乏上述任一特征的断指0%的存活率。
