[转帖]自体和异体滑膜内外肌腱移植的实验研究

汪洋

陈祥圣　王澍寰　胡溱　张友乐　孟淑琴
100035 北京积水潭医院手外科，北京市创伤骨科研究所［陈祥圣（现在湖南省桃源县人民医院415700）、王澍寰、胡溱、张友乐，病理科（孟淑琴）

关键词: 腱；同种；移植

　　【摘要】　目的　探讨上肢肩关节周围或上臂近端离断再植的适应证。 方法　对4例上肢高位离断患者的病史、术后功能的恢复进行了回顾性分析。 其中1例肩胛带离断者再植获得成功，在国内外尚属首次。 结果　肩胛带离断再植者术后肩关节外展45°，另3例可达90°。 4例肘关节、腕关节的伸屈运动基本达到正常范围；拇、手指屈伸活动恢复比较满意。 术后1年半，行手部功能重建术后，手的抓握及对指功能恢复。 结论　上肢高位离断再植的适应证是肢体完整、缺血时间短，神经非根性撕脱伤，且患者年轻、全身状况好者，应尽量予以再植。

Follow - up report of replantation of the upper extremity amputated around the shoulder joint　

FANG Guangrong, CHENG Guoliang, TANG Haiping, et al. Department of Hand Surgery, 401 Hospital of PLA， The Hand Surgery and Microsurgery Center of CPLA, Qingdao 266071

　　【Abstract】　Objective　To discuss the surgical indications for replantation of the upper extremity amputated around the shoulder joint or at the very proximal part. Methods　　Four cases of proximal level upper arm replantation were reviewed for the whole course of replantation procedures and the postoperative functions. All the cases were followed up for 2 to 4 years. One of the four cases was of upper limb amputation between scapulo-thoracic joint which was the first case in the medical literature. Results　　Shoulder abduction reached 90 degrees in 3 cases and 45 degrees in the case amputated at the shoulder girdle. In all 4 cases, the range of motion of the elbow joint and the wrist joint was almost normal. Restoration of ROM of the thumb and finger flexion and extension was satisfactory. Functional reconstruction of the hand intrinsic functions done one and a half years later led to restoration of grip and opposing function. Conclusions　　The surgical indications for replantation of the upper extremity amputated at high level were impact amputated limb, short ischemic period, non-avulsive nerve injury, and promising general condition in young patients.
　　【Key words】　Replantation　　Shoulder joint　　Microsurgery　　Treatment outcome

　　上肢高位离断是指肩关节附近的断肢,在该平面离断后能再植的机会不多。 其原因是肢体挫伤太重、肢体大段缺损或缺血时间太长等,而不宜进行再植。 有的病例即使进行了再植,其功能恢复也较差。 故此类断肢再植后的致残率较高。 1994年以来，我院对4例上肢高位离断者进行了再植,取得了较好的功能恢复。

资料与方法
　　1. 一般资料：本组共4例,男2例,女2例:年龄17 ～ 25岁。 均系工人。 伤因及离断部位:1例因上肢卷入快速的传送带,而引起右上肢连同肩关节、肩胛骨一起被撕脱致完全性离断(我们称为肩胛带离断）。 1例左上肢被冲床卷入后快速回抽,致肱骨外科颈处撕脱性离断。 另2例为吊车吊秆砸伤、砖瓦机齿轮挤伤致上臂上端完全性离断。
　　2. 再植方法：4例离断部位、伤后距再植时间、骨固定和动静脉的吻合、神经缝合及缺血时间等见表1。 再植手术及顺序均按断肢再植的原则进行。

表1　4例高位断肢再植一览表

例号	离断部位	伤后距手术时间	骨固定方法	吻合动脉	吻合静脉	缝合神经	缺血时间	结果
1