摘要
目的探讨于术探查在断指再植术后超敏期(再植术后48～96h)出现顽固性动脉危象的处理意义。方法1995年2月～2005年2月,将拇指近节完全离断再植术后超敏期出现顽固性动脉危象患者171例随机分为手术探查组(87例)与保守治疗组(84例),两组患者年龄、性别、吸烟比例、受伤情况及再植手术情况比较均无显著差异(P＞0．05)。手术探查组在出现顽固性动脉危象后积极予急诊手术探查,术中找出动脉痉挛或(和)血栓形成段,予切除后行动脉端端吻合或取前臂静脉移植修复指动脉。保守治疗组予罂粟碱30mg肌注；尿激酶2万U加入20mL生理盐水静脉推注,0．5～1h后如无缓解重复推注；安定镇静及镇痛药止痛等保守处理。观察再植指体成活情况。结果手术探查组成活78例,成活率为89．7％；保守治疗组成活41例,成活率为48．8％,两组差异有显著性意义(P＜0．01)。两组均无明显并发症发生。结论在断指再植术后超敏期出现顽固性动脉危象的处理中,手术探查可明显提高成活率、改善预后,不能轻易发弃。
Objective To evaluate the significance of surgical exploration for the refractory arterial crisis during the hypersensitive period （48 h to 96 h） after replantation of severed fingers. Methods One hundred and seventy-one patients experienced refractory arterial crisis during the hypersensitive period after replantation of the proximal thumb from February 1995 to February 2005 in our department. Eighty-seven of them were managed with surgical exploration, including incision injury （n = 6）, saw injury （n = 17）, rotation and avulsion injury （n = 30）, and crush injury （n = 34）. Eighty-four cases received conservative treatment, including incision injury （n = 6）, saw injury （n = 16）, rotation and avulsion injury （n = 29）, and crush injury （n = 33） . In the surgery group, the emergent explorations were performed as soon as the refractory arterialcrisisarose. Ifarterial spasm or /and thrombosis were found, the involved parts were resected before the artery ends were anastomosed or the finger artery was repaired by cubital vein graft. In the other group, conservative managements were carried out by using intramuscular injection of 30 mg Papaverine and intravenous injection of 20, 000-unit Urokinase in 20 mL normal saline, If symptoms were not alleviated after half an hour, the procedures were repeated. The conservative managements also included abirritative antipsychotics and analgesia of anodyne. Meanwhile, the survival state of all the digital replants was observed. Results In the surgery group, 78 fingers survived, the surviving rate being 89.7%. In the conservative group, 41 fingers survived with a surviving rate of 48.8%. The difference was statistically significant （ P 〈 0. 01 ）. No obvious complications happened in the two groups. Conclusion Since surgical exploration is crucial to management of refractory arterial crisis during the hypersensitive period after replantation of severed fingers, it should not be readily abandoned.
出处
《中华创伤骨科杂志》
CAS
CSCD
2006年第6期512-514,共3页
Chinese Journal of Orthopaedic Trauma
关键词
手术探查
断指再植
动脉危象
Surgical exploration
Digital replantation
Arterial crisis
