The comprehensive rehabilitative treatment was used in 58 cases(194 finger)for functional impairment after eplantation. After the treatment the overall increase of flexion-extension range of motion was 30 to 130 degrees respectively. From the assessment of 10 items of daily activities, the patients could accomplish three-fourth of them. the average time taken for the treatment was 3 months with an excellent-good rate about 87.4%. Through the early comprehensive rehabilititive treatment patients could achieve better results.
The method of diversion of the arteryvein flow was used for vascular anastomosis in 12 cases undergoing replantation of the severed limbs(fingers)and free tissue transplantations. The results from this method were successful. The efficacy of this method of re-establishment of the blood circulation broadened the indications for replantation and also provided a method of choice in cases when there was impediment of the venous return during tissue transplantation.
目的 探讨末梢灌注指数（TPI）在断指再植术后对血管危象早期诊断的价值。 方法 对2005年1月－2011年10月31例36个再植指运用Agilent V24C监护仪血氧饱和度探头进行持续TPI监测，同时观察记录术后再植指皮温、色泽、肿胀程度及毛细血管搏动情况，将发生血管危象的再植指分为危象组（n=4），将未发生血管危象的再植指分为对照组（n=32），分析发生危象前12 h至危象发生时的TPI，每2小时为一时间段，共7个时相，分别记为T1~T7。 结果 对照组各时间点TPI无明显变化，各时间点比较差异无统计学意义（P＞0.05）；危象组从T4开始，TPI呈逐渐下降趋势，与前一时间点比较差异均有统计学意义（P＜0.05）。两组TPI在T1、T2、T3时比较差异无统计学意义（P＜0.05）；从T4开始，危象组TPI均较对照组降低，差异有统计学意义（P＜0.05）。 结论 TPI监测能够无创、实时、灵敏地反映断指再植术后再植指血供情况，可早于临床症状以前对断指再植术后血管危象作出诊断，有较高的临床应用价值。
Objective To study the effect of internal fixation with absorbable intramedullary nail on the treatment of phalange fractures in replantation of severed finger. Methods From September 2001 to October 2003, 28 cases with industrial severed finger (21 males and 7 females, with the age of 18-35 years) were replanted within 1-6 hours. The severed locations were index fingers in 11 cases, middle fingers in 8 cases, ring fingers in 6 cases, little fingers in 3 cases. All cases of phalange fractures were fixed by absorbable intramedullary nails of poly-DL-lactic acid(PDLLA) that combined with chitosan. Out of the 28 cases, 15 cases were with proximal phalange, 11 cases were with middle phalange, 2 cases were with distal phalange. The bone marrow cavity of the phalanges were dilated, then the intramedullary nail was inserted with suitable diameter and length to fix the fracture. Postoperatively resin bandage was applied for 3-4 weeks.Results All the 28 patients survived the performance and postoperative follow-up ranged from 3 to 10 months(4 months in average). Rejection was observed in one case 3 weeks after operation, bone unions were obtained in other cases. According to the Chinese Medical Association’s evaluation standard for replantation of amputated finger, 18 fingers resulted in excellence, 9 fingers in good function and 1 with unsatisfactory function. The excellent and good rate was 96.4%. Conclusion Internal fixation with absorbable intramedullary nail of PDLLA combined with chitosan proves to be effective in the replantation of severed finger.
To investigate the significance of activated platelet levels before and after surgical operation in patients with severed finger by severe injury, the P-selectin (CD62p) positive platelet percent in peripheral blood was studied in 32 patients before and after operation by flow cytometric immunology. At the second and third day after operation, seventeen patients, which in a high positive platelet percent, were measured again after anticoagulation treatment with a large dose of urokinase etc. The results were that the levels of CD62p positive platelet in peripheral blood before and after operation were significantly higher than that of the normal group (P lt; 0.01). The CD62p positive platelet percent was increased not much more in the anti-coagulation patients than in the normal ones (P gt; 0.05). There were a few vascular crisis observed. This study suggested that severed fingers by a crushing or wringing injury enhance the platelet activity and resulted in hypercoagulation, thus anti-coagulation measures should be taken to avoid possible thrombosis and improve the survival rate of replantation. CD62p was one of the sensitive indices of activated platelet, which could be used in calculating hypercoagulation accurately.