陈祥圣 王澍寰 胡溱 张友乐 孟淑琴 100035 北京积水潭医院手外科，北京市创伤骨科研究所[陈祥圣(现在湖南省桃源县人民医院415700)、王澍寰、胡溱、张友乐，病理科(孟淑琴) 中华手外科杂志 1999 0 15 4


    关键词：腱；同种；移植 期刊 zhswkzz 0 基础研究 fur -->


    

【摘要】 目的 探讨上肢肩关节周围或上臂近端离断再植的适应证。方法 对4例上肢高位离断患者的病史、术后功能的恢复进行了回顾性分析。其中1例肩胛带离断者再植获得成功，在国内外尚属首次。 结果 肩胛带离断再植者术后肩关节外展45°，另3例可达90°。4例肘关节、腕关节的伸屈运动基本达到正常范围；拇、手指屈伸活动恢复比较满意。术后1年半，行手部功能重建术后，手的抓握及对指功能恢复。 结论 上肢高位离断再植的适应证是肢体完整、缺血时间短，神经非根性撕脱伤，且患者年轻、全身状况好者，应尽量予以再植。

Follow - upreport of replantation of the upper extremity amputated around the shoulder joint

FANG Guangrong, CHENG Guoliang, TANG Haiping, et al. Department of Hand Surgery, 401 Hospital of PLA， The Hand Surgery and Microsurgery Center of CPLA, Qingdao 266071

【Abstract】 Objective To discussthe surgical indications for replantation of the upper extremity amputated around theshoulder joint or at the very proximal part. Methods Four cases of proximal level upper arm replantation were reviewedfor the whole course of replantation procedures and the postoperative functions. All thecases were followed up for 2 to 4 years. One of the four cases was of upper limbamputation between scapulo-thoracic joint which was the first case in the medicalliterature. Results Shoulderabduction reached 90 degrees in 3 cases and 45 degrees in the case amputated at theshoulder girdle. In all 4 cases, the range of motion of the elbow joint and the wristjoint was almost normal. Restoration of ROM of the thumb and finger flexion and extensionwas satisfactory. Functional reconstruction of the hand intrinsic functions done one and ahalf years later led to restoration of grip and opposing function. Conclusions The surgical indications for replantation of the upper extremityamputated at high level were impact amputated limb, short ischemic period, non-avulsivenerve injury, and promising general condition in young patients.

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