Weinzweig N, Sharzer L A, Starker I
Division of Plastic Surgery, University of Illinois at Chicago 60612-7316, USA.
J Hand Surg Am. 1996 Sep;21(5):877-83. doi: 10.1016/S0363-5023(96)80208-5.
Thirteen consecutive transmetacarpal replantations and revascularizations in 12 patients were reviewed retrospectively. Ten patients (11 hands) sustained crush injuries, 1 withstood an explosive blast, and 1 suffered a guillotine amputation. Nine revascularizations (1 thumb and 31 fingers) and 4 replantations (1 thumb and 16 fingers), including bilateral procedures in 1 patient, were performed. Forty-four of 49 replantable digits (90%) were salvaged. Ten patients (11 hands) required secondary surgery (mean, 4.5 procedures per hand), 29 of 49 (60%) for tendon and joint scarring and 7 of 20 (14%) for nonunions or malunions. Range of motion averaged 109 degrees per digit. Intrinsic muscle function and pinch and grip strengths were weak or absent. Recovery of sensibility was poor. According to Chen et al.'s grading system of functional return, 4 (31%) were grade II, 4 (31%) were grade III, and 5 (38%) grade IV. The follow-up period ranged from 2.5 to 11 years. Only 1 patient resumed his prior occupation (as supervisor); 2 were permanently disabled, 3 pursued new and unrelated occupations, 2 were still in therapy, and 4 were lost to late follow-up evaluation. None of the manual laborers (11 patients) were able to return to their preinjury livelihood. Despite these discouragingly poor results, all patients were satisfied with the surgery.
对12例患者的13例连续性经掌骨再植及血管重建手术进行了回顾性研究。10例患者（11只手）为挤压伤，1例遭受爆炸伤，1例为切割伤。共进行了9例血管重建手术（1例拇指和31例手指）和4例再植手术（1例拇指和16例手指），其中1例患者为双侧手术。49个可再植手指中有44个（90%）得以挽救。10例患者（11只手）需要二次手术（平均每只手4.5次手术），49例中有29例（60%）因肌腱和关节瘢痕形成，20例中有7例（14%）因骨不连或骨畸形愈合。每个手指的平均活动范围为109度。内在肌功能以及捏力和握力较弱或缺失。感觉恢复较差。根据Chen等人的功能恢复分级系统，4例（31%）为II级，4例（31%）为III级，5例（38%）为IV级。随访时间为2.5至11年。只有1例患者恢复了之前的工作（担任主管）；2例永久性残疾，3例从事新的无关职业，2例仍在接受治疗，4例失访。所有体力劳动者（11例患者）均无法恢复伤前的生计。尽管结果令人沮丧，但所有患者对手术都很满意。
