Waikakul S, Vanadurongwan V, Unnanuntana A
Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Bone Joint Surg Br. 1998 Nov;80(6):1024-30. doi: 10.1302/0301-620x.80b6.8761.
We performed a prospective study in 186 patients with a minimum follow-up of two years in order to attempt to predict successful major re-implantation of the upper limb. There were 137 men and 49 women with 24 amputations of the palm, 75 of the wrist, 50 of the forearm, 9 disarticulations through the elbow, and 28 amputations through the upper arm. The degree of injury to the amputated segment and the stump were good predictors of the rate of success and the final outcome. Adequate preservation, contraction of the muscle in the amputated part after stimulation, the level of injury and a smoking habit were fair indicators, but the serum potassium concentration in the amputated segment was the best objective predictor. When it is higher than 6.5 mmol/l 30 minutes after re-perfusion, re-implantation should be avoided. A high systemic venous serum potassium concentration was also found before clinical signs of the re-perfusion syndrome were seen.
我们对186例患者进行了一项前瞻性研究，至少随访两年，以试图预测上肢主要再植手术的成功。其中男性137例，女性49例，手掌截肢24例，腕部截肢75例，前臂截肢50例，经肘关节离断9例，上臂截肢28例。截肢段和残端的损伤程度是成功率和最终结果的良好预测指标。保存良好、刺激后截肢部位肌肉收缩、损伤程度和吸烟习惯是合理的指标，但截肢段血清钾浓度是最佳的客观预测指标。再灌注30分钟后血清钾浓度高于6.5 mmol/l时，应避免再植。在再灌注综合征的临床体征出现之前，也发现全身静脉血清钾浓度较高。
