摘要
目的 通过对患手功能的恢复情况以及足部供区切取组织后功能情况进行长期随访,来评价应用5块游离组织移植一期修复全手撕脱伤的疗效.方法 对7例采用5块游离组织移植一期修复全手撕脱伤的患者进行长期随访,随访离手术时间为3～12年,平均5.8年.对再造手和供足的评价方法：主观指标[DASH评分、Michigan手功能评价、足部Maryland评分（FPCS）];客观指标（捏力、握力、虎口距离、拇手指的关节活动度、再造指的两点分辨觉）;采用中华医学会手外科学会拇、手指再造功能评定试用标准评定优良率.结果 主观指标：再造手DASH评分平均为（21.60±16.58）分.Michigan手功能评价（平均）：其中整体手功能（67.50±24.05）%,日常活动（99.69±32.58）%,工作情况（49.57±25.45）%,疼痛（24.00±21.38）%,外观（48.20±7.11）%,满意度为（78.40±12.65）%.供足Maryland评分平均为（84.56±2.44）分.客观指标：再造拇掌指关节活动度平均为（56.00±20.77）°,示指掌指关节活动度平均为（78.00±10.33）°,中指掌指关节活动度平均为（76.00±9.00）°;再造手平均握力达健侧的46.70%;拇、示指平均捏力为健侧的66.52%,拇、中指平均捏力为健侧的61.30%;拇指指端两点分辨觉平均为（8.47±0.68）mm,再造手指指端两点分辨觉平均为（10.59±0.82）mm;手掌、手背感觉为S3-;供足除2例患者有色素沉着和少许瘢痕增生外,无疼痛等后遗症.按中华医学会手外科学会上肢部分功能评定试用标准评定：再造手功能优2例、良4例、可1例,优良率为85.71%.结论 用5块游离组织组合移植修复全手套状撕脱伤,恢复了较好的手功能,且随着术后时间的延长,手功能的恢复越好,对供足功能仅有轻微的影响.
Objective To evaluate the clinical outcomes of combined five tissue free transfer for reconstruction of whole hand skin avulsion injury by evaluating the long-term functional results of the hand and donor area. Methods Seven patients who underwent combined five tissue free transfer for reconstruction of whole hand skin avulsion were follow-up for 3 to 12 years postoperatively, with an average of 5.8 years.Subjectively, the donor site was evaluated with Maryland foot rating score, while the hand function was assessed by the DASH score and Michigan hand outcomes questionnaire. Objective measurements included pinch and grip strength, opening of the first web, active range of motion of the thumb and fingers, and two-point discrimination.The criteria for functional evaluation of reconstructed thumb and fingers issued by the Hand Surgery Society of Chinese Medical Association were used to determine the satisfactory rate. Results The average DASH score of hand function was 21.60 ± 16.58. Michigan questionnaire showed that the overall hand function was （67.50 ±24.05） %, activities of daily living （ 99.69 ± 32.58） %, working activities （49.57 ± 25.45 ） %, pain （24.00±21.38）%, appearance （48.20 ± 7.11）%, respectively. The satisfactory rate was （78.40 ±12.65）%o. The donor foot obtained （84.56 ± 2.44）%. Maryland foot rating score on average. The average range of motion of the metacarpophalangeal joint of the reconstructed thumbs reached （ 56.00 ± 20.77）°, while that of the index fingers （78.00 ± 10.33）°and middle fingers （76.00 ± 9.00）°. Grip strength of the reconstructed hands reached 46.70% of that of the healthy side. The average thumb-index finger pinch strength reached 66.52% of the healthy side, while the thumb-middle finger pinch strength was 61.30% of the healthy side on average. Two-point discrimination measured （8.47 ± 0.68） mm at thumb pulps and （ 10.59 ± 0.82） mm at finger pulps. Sensation of the palm and dorsum of the hand was graded as S3-. Except the pigmentation and slight scarring in the donor foot in two cases, there were no complications such as pain to the donor sites. The function of the reconstructed hand was rated as excellent in 2 cases, good in 4 cases and fair in 1 case, according to the Hand Surgery Society of Chinese Medical Association criteria, achieving an overall 85.71% satisfactory rate. Conclusion Combined five tissue free transfer for reconstruction of whole hand skin avulsion leads to satisfactory hand function restoration. The longer the postoperative interval, the better the hand function. There is only slight affect to the donor foot.
出处
《中华手外科杂志》
CSCD
北大核心
2010年第5期274-276,共3页
Chinese Journal of Hand Surgery
关键词
外科皮瓣
随访研究
手损伤
Surgical flaps
Follow-up studies
Hand injuries
