| 林秉爔,张贵友.手指末节完全离断患者断指再植成活率的影响因素分析[J].中国烧伤创疡杂志,2024,(4):279~282. |
| DOI： |
| 中文关键词: 手指末节 完全离断 断指再植 成活率 影响因素 |
| 英文关键词:Fingertip Complete amputation Severed finger replantation Survival rate Influencing factors |
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| 中文摘要: |
| 【摘要】 目的 分析探讨手指末节完全离断患者断指再植成活率的相关影响因素。 方法 选取 2019 年 1 月至 2022 年 1 月仓山海福医院收治的 120 例拟行断指再植治疗的手指末节完全离断患者作为研究对象, 收集患者性别、年龄、致伤原因、热缺血时间、断指保存方式、术后皮肤温度、术后指腹弹性、有无血管痉挛、有无血栓形成、治疗依从性及术后 3 个月内断指成活情况等资料, 并根据断指成活情况将其分为成活组和未成活组, 多因素 Logistic 回归分析手指末节完全离断患者断指再植成活率的影响因素。 结果 断指再植术后 3 个月, 120 例手指末节完全离断患者中断指成活 106 例 (88.33%), 设为成活组; 断指未成活14例 (11.67%), 设为未成活组。单因素分析结果显示, 未成活组致伤原因为挤压伤、热缺血时间>6 h、术后皮肤温度略低、术后指腹弹性差、有血管痉挛及血栓形成、治疗依从性差的患者比例均明显高于成活组 ( χ2 = 8.739、18.723、19.569、21.835、15.340、13.894、27.941, P= 0.013、P<0.001、P<0.001、P<0.001、P<0.001、P<0.001、P<0.001); 多因素Logistic 回归分析结果显示, 热缺血时间>6 h、术后皮肤温度略低、术后指腹弹性差、有血管痉挛及治疗依从性差是影响手指末节完全离断患者断指再植成活率的独立危险因素 ( 95% CI 为 2.298 ~ 16.314、1.328 ~ 17.859、1.774~ 19.234、1.287~ 21.978、1.328~ 21.054, P = 0.000、0.017、0.004、0.021、0.004)。 结论 手指末节完全离断患者断指再植成活率与热缺血时间、术后皮肤温度、术后指腹弹性、有无血管痉挛及治疗依从性等因素密切相关, 临床应正确识别其高危因素, 及时制定针对性治疗措施, 以提高断指再植成活率。 |
| 英文摘要: |
| 【Abstract】 Objective To analyze influencing factors for the survival rate of severed finger replantation in patients with complete fingertip amputations. Methods 120 patients with complete fingertip amputations, admitted to Cangshan Haifu Hospital for severed finger replantation from January 2019 to January 2022, were selected as research subjects. Patients’ data, including sex, age, cause of injury, warm ischemia time, preservation method of severed finger, postoperative skin temperature, postoperative elasticity of finger pulp, with vasospasm and thrombosis or not, treatment compliance, and survival rate of severed finger within three months after the operation, were collected. Patients were divided into the survival group and the non?survival group based on the survival condition of the severed fingers. Multivariate Logistic regressionanalysis was used to analyze the influencing factors for the survival rate of severed finger replantation in patients with complete fingertip amputations. Results Three months after the severed finger replantation surgery, among the 120 patients with complete fingertip amputations, 106 cases (88.33%) realized the implanted fingertip survival, being set as the survival group, and the other 14 cases (11.67%) failed to realize the implanted fingertip survival were set as the non-survival group. The results of the univariate analysis showed that the proportions of patients with crush injuries, warm ischemia time > 6 hours, lower postoperative skin temperature, postoperative poor elasticity of finger pulp, with vasospasm and thrombosis, and inadequate treatment compliance were significantly higher in the non-survival group compared with the survival group(χ2 = 8.739, 18.723, 19.569, 21.835, 15.340, 13.894 and 27.941, P = 0.013, P<0.001, P<0.001, P<0.001, P<0.001, P<0.001, P<0.001). Multivariate Logistic regression analysis showed that warm ischemia time > 6 hours, lower postoperative skin temperature, postoperative poor elasticity of finger pulp, with vasospasm and thrombosis, and inadequate treatment compliance were independent risk factors influencing the survival rate of replanted fingertip in patients with complete fingertip amputations ( 95% CI: 2.298- 16.314, 1.328- 17.859, 1.774- 19.234, 1.287- 21.978 and 1.328 -21.054, P= 0.000, 0.017, 0.004, 0.021 and 0.004). Conclusion The survival rate of severed finger replantation in patients with complete fingertip amputations is closely related to factors such as warm ischemia time, postoperative skin temperature, postoperative elasticity of finger pulp, the occurrence of vasospasm, and treatment compliance. Therefore, high-risk factors should be identified correctly and targeted measures should be made timely in clinical practice to improve the survival rate of the implanted severed fingertip. |
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