摘要
目的探讨采用逆行法再植治疗多足趾离断的临床经验及治疗效果。方法自2013年1月对9例32趾多足趾离断伤患者采用逆行法再植。顺序为清创→缝合跖侧皮肤→缝合趾屈肌腱→吻接趾底固有动脉、神经→趾骨复位固定→缝合趾伸肌腱→吻合趾背静脉→缝合趾背皮肤。结果9例32趾再植中成活26趾;其中1例左足1-5趾离断伤术后30h,再植第2趾出现血管危象,经探查术后成活;坏死5例6趾,成活率81.2%。术后8~12周骨折愈合,平均11周。术后随访6~24个月,平均10个月,其中1例趾趾甲畸形明显,余趾体外形恢复良好,足趾关节总活动度为20°~60°,趾尖的两点辨别觉10~16 mm,患者行走步态恢复基本正常。结论采用逆行法再植治疗多足趾离断伤,术中操作简便,视野暴露良好,效果满意。
Objective To explore the clinical experience and treatment effects of retrograde replantation for treatment of amputation injury of multiple toes.Methods Thirty-two toes in 9 cases with multiple toes were treated by retrograde replantation.The surgical sequence was debridement and suture of the metatarsal skin.Then the toe flexor tendon was sutured and the proper plantar digital arteries and nerves were anastomosed.The phalange was reduced and fixed after the extensor tendon was sutured.Finally,dorsal veins were anastomosed and the dorsal digital skin was sutured.Results Among 32 toes in 9 cases treated by replantation in this group,26 toes survived.Vessel crisis occurred in the second toe 30 hours after replantation in case with 1-5 toes amputation.Necrosis occurred in 6 toes in 5 cases.The survival rate was 81.2%.The bone fractures healed 8 to 12 weeks after operation,with an average of 11 weeks.The patients were followed up from 6 months to 24 months with the average time of 10 months.The appearance of the repaired toe was good,except for one case with deformity of hallux nail.The total motion of toe joint was from 20°to 60°.The two-point discrimination of toe tip was from 10mm to 16mm.The patients walked well.Conclusion It is a sample method to treat amputation injury of multiple toes by using retrograde replantation.The surgical visual field could be well exposed.The satisfactory effects are obtained.
作者
刘跃飞
徐浩
周荣
胡昌庆
陈鲁成
耿超
张广亮
侯瑞兴
LIU Yuefei;XU Hao;ZHOU Rong(Department of Foot and Ankle Surgery,Ruihua Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215104,China)
出处
《实用手外科杂志》
2021年第1期3-5,12,共4页
Journal of Practical Hand Surgery
基金
江苏省青年医学人才项目(项目编号:QNRC2016223)。
关键词
足趾
离断
逆行法
再植
显微外科
Toes
Amputation
Retrograde method
Replantation
Microsurgery
