[转帖]毁损性手外伤的早期修复与功能重建

汪洋

丛海波　隋海明　李金晟
文登整骨医院山东文登，264400

关键词: 手；毁损伤；修复；功能重建

　　【摘　要】　　目的　寻找手部大范围多元组织毁损后组织修复及功能重建的最佳方法。方法　1990年1月～1999年6月，采用急症(33例)、亚急症(伤后三天内，26例)吻合血管的组织移植或复合组织移植的方法一期修复毁损组织并重建手部功能。对手部桡侧的再造采用皮瓣与足趾组合时于皮瓣局部打孔的方法将再造拇指引出，解决虎口瘢痕挛缩；在游离第二足趾的同时游离伸、伸趾短肌或短展肌组合移植重建再造拇指对掌功能；对受区无可供吻合血管或可供吻合血管数量不足，采用Y型静脉倒置、顺置搭桥或母体血管分支搭桥的方法予以解决。临床应用59例中组合组织移植51例，复合组织移植4例，腕掌及手指离断再植的同时进行组织移植4例。结果　120个移植组织全部成活，无一例感染及坏死，手部功能均获得良好恢复。结论　采用急症、亚急症吻合血管的组织移植或复合组织移植的方法一期修复毁损组织并重建手部功能是手部大范围多元组织毁损后理想的修复重建方法。

STUDY ON EARLY REPAIR OF DESTRUCTIVE HAND INJURY AND RECONSTRUCTION OF HAND FUNCTION／CONG

Hai-bo, SUI Hai-ming, LI Jin-sheng. （Wendeng Orthopedic Hospital. Wendeng Shandong. P.R. China 264400）

　　【Abstract】　　Objective　To investigate a clinical method in repairing destructive hand injury and reconstructing hand function in early stage. Methods　From January 1990 to June 1999, composite tissue transplantation was used to repair destructive hand damage and reconstruct hand function with vascular anastomosis in emergency (33 cases) or subemergency (126 cases). For the radial damage, combined flaps with toes was used to treat cicatricial contracture of thumb-web space. Opposing function of thumb was reconstructed by combined transplantation of short extensor muscle of great toe, short extensor muscle of toes or short abductor muscle of great toe in the same time of freeing the second toe. For no or deficient anastomosing vessles in donor site, “Y” —shaped reversal vein, anterograde bridging, or branches bridging of host vessels were applied. Results　All of tissue transplantation were survived, including combined tissue transplantation in 51 cases, composite tissue transplantation in 4 cases, tissue transplantation after replantation of severed wrist and finger in 4 cases, there were no infection or necrosis in all cases, and hand function recovered well. Conclusion　It is an ideal procedure to repair destructive hand injury and reconstruct hand function by combined or composite tissue transplantation with vascular anastomosis in emergency or subemergency.
　　【Key words】　　Hand 　　Destructive injury　　Repair　　Function reconstruction

　　手部外伤性大范围多元组织毁损临床并不少见，如何早期有效地修复毁损组织并重建手部功能，是临床治疗的一大难题。我院1990年1月～1999年6月对59例手部急性外伤性大范围多元组织毁损的患者，采用急症、亚急症(伤后三天内)吻合血管组织移植的方法一期修复毁损组织并重建手部功能，取得了移植组织全部成活，无一例感染，手部功能恢复良好的临床效果，现报告如下。

1　临床资料

1.1　一般资料