Clinical efficacy of finger replantation in the treatment of complete distal segment finger amputations and the analysis of the factors affecting the survival rate of patients with replantation of severed finger / 中国综合临床

ABSTRACT

Objective To observe the clinical effect of replantation and non-finger replantation in the treatment of complete distal segment finger amputations,and to analyze the related factors affecting the survival rate of replantation of amputated finger,so as to provide an objective reference for clinical treatment. Methods From March 2015 to June 2016,sixty-two patients with complete distal segment finger amputations treated in the Third People's Hospital of Huizhou were randomly divided into two groups the observation group and the control group according to the random number table method. The observation group was treated with finger replantation (Pancreatic repair,orthotopic suture and stump remodeling); the two groups of patients with early finger survival rate,replanting fingernail growth,two points discrimination,distal fingertips The clinical data of 288 patients with replantation of single finger rupture were analyzed retrospectively. The clinical data were divided into two groupsthe survivors group,the survivors group 74 cases,compared the clinical data of the two groups of patients,analysis of the impact of replantation of the survival rate of the relevant factors. Results The survival rate of early finger was 8. 57% ( 3/ 35) in the observation group and 15. 15% ( 5/ 33) in the control group, the difference was not statistically significant (χ2 = 0. 216,P>0. 05). At 6 months after operation,the length of nail growth,the two-point discrimination and the distal interphalangeal mobility were significantly better than those in the control group((13. 5±2. 9)mmvs. (11. 8±2. 2)mm);(4. 6±0. 3)mmvs. (7. 5±0. 6)mm;(62. 5±4. 4)°vs. (45. 3±3. 6)°) (P<0. 05) . After 6 months,the observation group The excellent and good rate of finger joint activity was 93. 55% (29/ 31). The excellent rate of joint activity was 70. 97% (22/ 31) in the control group,the difference was statistically significant (χ2 = 3. 979,P<0. 05) 288 cases of replantation of clinical data found that smoking history,type of injury,warm ischemic time,degree of disruption,cross-section thrombosis,postoperative skin temperature,pulp elasticity and postoperative psychological status can affect the replantation ( P< 0. 05) . Multivariate logistic regression analysis showed that the factors affecting the survival rate of replantation of finger injury were significantly higher than those of severe depression(OR5. 698,95%CI2. 892- 8. 738,P< 0. 001)>complete disconnection(OR5. 389,95%CI2. 672-7. 964,P<0. 001) >warm ischemic time more than 6 hour (OR4. 515,95%CI1. 366-8. 847,P<0. 001)>postoperative section Thrombosis 成(OR3. 287,95%CI2. 543~9. 678,P< 0. 001) > low postoperative skin temperature ( OR2. 142,95% CI1. 243 - 5. 212,P < 0. 001) > poor postoperative knee elasticity(OR2. 008,95% CI1. 117- 5.449,P< 0. 001) . Conclusion In the treatment of patients with complete injury from the end of the finger,the effect of replantation of the finger is significantly improved,which can improve the postoperative joint activity and improve the appearance and function of the finger. The period of severe depression,complete disconnection and warm ischemia is long Affect the survival rate of finger replantation of the main risk factors for the above factors targeted measures can improve the survival rate of finger replantation.