复杂性大肢体离断再植的临床研究

发布时间：2018-05-24 00:01

本文选题：复杂性 + 肢体离断　；参考：《济南大学》2015年硕士论文

【摘要】：[目的]回顾性分析我院收治的复杂性肢体离断病例,探讨复杂性肢体离断伤再植的适应征、肢体的保存方法及手术方式选择、相对应康复治疗,提供经验性参考意见,有助于提高临床疗效。[方法]对我院2009年10月至2014年10月收治的15例复杂性断肢再植手术患者的临床资料进行回顾性分析,完全离断伤12例,不完全离断伤3例。术前对所有患者的断肢进行有效地肢体保护。此组病例中,均同时伴不同程度皮肤、骨骼、血管等组织缺损,此组患者均不同程度给予骨质短缩,重建骨骼的连续性,其中1例下肢离断肢体成活后行骨骼延长术,2例患者因血管缺损过长,进行血管移植桥接,其中3例同时合并骨骼、皮肤、神经、血管缺损,骨质短缩后,采用组织复合移植手术,此组病例中离断肢体的重要肌肉一期可以修复者予以修复,不能修复者可待后期行功能重建手术。对于皮肤软组织缺损面积较大,骨质及肌腱外露者,一期使用封闭式负压吸引闭合伤口,二期行皮瓣修复手术解决了清创后的组织缺损问题。15例复杂性肢体离断伤中,机器伤8例,电锯伤2例,车祸伤4例,刀砍伤1例,全部再植成功,术后分别在术后不同时段对应性制定了康复计划。[结果]15例全部成活,其中一例前臂下段因组织碾挫严重,血管损伤较重,断端新鲜化后吻合动静脉血管比例1：1,5小时后肢体出现静脉危象,急诊行探查术,术中见吻合口处血栓形成,术中清除血栓后,再次吻合,术后成活良好。后期经创面修复手术、功能重建及康复治疗后,随访5个月-4年,根据陈中伟院士肢体功能评价标准：1)、优：恢复原工作；2)、良：参加轻工作；3)、差：不能工作,但能自理生活；4)、劣：不能工作,也不能生活自理。综合评价为上肢优3例,良3例,差1例,下肢优5例,良3例。[结论]复杂性肢体离断伤临床上多伴有不同程度复合组织损伤,病情复杂,临床工作中应根据具体病情制定个体化手术方案,这样有利域肢体再植成功率及再植术后肢体攻能恢复能力的提高。
[Abstract]:[objective] to analyze retrospectively the complex limb amputation cases in our hospital, to discuss the adaptation sign, the preservation method and the operation mode of the complex limb amputation injury, and to provide the experience reference for the corresponding rehabilitation treatment. It is helpful to improve the clinical effect. [methods] the clinical data of 15 patients with complicated amputated limb replantation admitted in our hospital from October 2009 to October 2014 were retrospectively analyzed. 12 cases were completely amputated and 3 cases were incomplete amputated. All patients with amputated limbs were effectively protected before operation. In this group, skin, bone, blood vessels and other tissue defects were all accompanied by different degrees of bone shortening, bone reconstruction continuity, and so on. Among them, one patient underwent bone lengthening after the limb was cut off, and 2 patients underwent vascular graft because of the long vascular defect. Among them, 3 cases were complicated with bone, skin, nerve, vascular defect and bone shortening. In this group, the major muscle of the broken limbs can be repaired in one stage, and the patients who can not be repaired can be treated with functional reconstruction in the later stage. For those with large area of skin and soft tissue defect and exposed bone and tendon, closed negative pressure was used to draw the closed wound in one stage, and the second stage flap repair operation solved the problem of tissue defect after debridement. There were 8 cases of machine injury, 2 cases of chainsaw injury, 4 cases of traffic accident injury and 1 case of knife cut wound. All of them were successfully replanted. The corresponding rehabilitation plan was worked out at different time after operation. [results] all of the 15 cases survived, one of them had severe tissue crush and severe vascular injury, and the proportion of anastomosed arterial vessels after fresh anastomosis of the broken end appeared venous crisis in the extremities 5 hours after 1: 1h, and the emergency exploration was performed. Thrombosis at anastomotic site was seen during the operation. After removing the thrombus during operation, anastomosis was performed again, and the survival rate was good. The patients were followed up for 5 months to 4 years after the wound repair operation, functional reconstruction and rehabilitation treatment. According to the Chen Zhongwei academician limb function evaluation standard: 1, excellent: restore the original work, good: take part in light work, poor: unable to work. But can take care of oneself to live 4, bad: can't work, also can't live to take care of oneself. The results were as follows: superior upper limb in 3 cases, good in 3 cases, poor in 1 case, excellent in lower extremity in 5 cases and good in 3 cases. [conclusion] complicated limb amputation injury is often accompanied with complex tissue injury in different degrees, so the individual operation plan should be made according to the specific condition in clinical work. The success rate of limb replantation and the recovery ability of limb attack after replantation were improved.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.1

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