本文選題：復(fù)雜性 + 肢體離斷�。� 參考：《濟(jì)南大學(xué)》2015年碩士論文

【摘要】：[目的]回顧性分析我院收治的復(fù)雜性肢體離斷病例,探討復(fù)雜性肢體離斷傷再植的適應(yīng)征、肢體的保存方法及手術(shù)方式選擇、相對(duì)應(yīng)康復(fù)治療,提供經(jīng)驗(yàn)性參考意見,有助于提高臨床療效。[方法]對(duì)我院2009年10月至2014年10月收治的15例復(fù)雜性斷肢再植手術(shù)患者的臨床資料進(jìn)行回顧性分析,完全離斷傷12例,不完全離斷傷3例。術(shù)前對(duì)所有患者的斷肢進(jìn)行有效地肢體保護(hù)。此組病例中,均同時(shí)伴不同程度皮膚、骨骼、血管等組織缺損,此組患者均不同程度給予骨質(zhì)短縮,重建骨骼的連續(xù)性,其中1例下肢離斷肢體成活后行骨骼延長術(shù),2例患者因血管缺損過長,進(jìn)行血管移植橋接,其中3例同時(shí)合并骨骼、皮膚、神經(jīng)、血管缺損,骨質(zhì)短縮后,采用組織復(fù)合移植手術(shù),此組病例中離斷肢體的重要肌肉一期可以修復(fù)者予以修復(fù),不能修復(fù)者可待后期行功能重建手術(shù)。對(duì)于皮膚軟組織缺損面積較大,骨質(zhì)及肌腱外露者,一期使用封閉式負(fù)壓吸引閉合傷口,二期行皮瓣修復(fù)手術(shù)解決了清創(chuàng)后的組織缺損問題。15例復(fù)雜性肢體離斷傷中,機(jī)器傷8例,電鋸傷2例,車禍傷4例,刀砍傷1例,全部再植成功,術(shù)后分別在術(shù)后不同時(shí)段對(duì)應(yīng)性制定了康復(fù)計(jì)劃。[結(jié)果]15例全部成活,其中一例前臂下段因組織碾挫嚴(yán)重,血管損傷較重,斷端新鮮化后吻合動(dòng)靜脈血管比例1：1,5小時(shí)后肢體出現(xiàn)靜脈危象,急診行探查術(shù),術(shù)中見吻合口處血栓形成,術(shù)中清除血栓后,再次吻合,術(shù)后成活良好。后期經(jīng)創(chuàng)面修復(fù)手術(shù)、功能重建及康復(fù)治療后,隨訪5個(gè)月-4年,根據(jù)陳中偉院士肢體功能評(píng)價(jià)標(biāo)準(zhǔn)：1)、優(yōu)：恢復(fù)原工作；2)、良：參加輕工作；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。綜合評(píng)價(jià)為上肢優(yōu)3例,良3例,差1例,下肢優(yōu)5例,良3例。[結(jié)論]復(fù)雜性肢體離斷傷臨床上多伴有不同程度復(fù)合組織損傷,病情復(fù)雜,臨床工作中應(yīng)根據(jù)具體病情制定個(gè)體化手術(shù)方案,這樣有利域肢體再植成功率及再植術(shù)后肢體攻能恢復(fù)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.
【學(xué)位授予單位】：濟(jì)南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R658.1

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