摘要
目的分析末节断指再植术后发生血管危象的危险因素,为预防血管危象的发生提供理论依据。方法总结65指末节断指再植病例,统计患者性别、年龄、指别、优势手别、伤因、断指缺血时间、断指保存方式、离断平面、血小板检测值、再植顺序、动脉修复方式、静脉回流方式、是否发生血管危象等因素,进行t检验、秩和检验或χ2检验等单因素分析并行多因素Logistic回归分析,判定再植术后血管危象发生的危险因素。结果65指末节断指再植术后有13指发生血管危象,发生率为20%。单因素分析结果表明,发生血管危象患者血小板检测值显著高于未发生者(P<0.01)。静脉回流方式(P<0.05)、伤因(P<0.05)、断指保存方式(P<0.05)、年龄(P<0.01)与血管危象发生有关。多因素Logistic回归分析,血小板检测值(OR=1.015,P<0.05)、年龄(OR=0.349,P<0.05)、静脉回流方式(OR=0.278,P<0.05)是血管危象发生的独立预测因素。6岁以下患儿血管危象发生率达61.5%,显著高于其他年龄组(P<0.05);单纯吻合静脉重建回流方式者危象发生率为43.8%,显著高于其他方法组(P<0.01)。结论年龄、血小板水平以及静脉回流方式是影响末节断指再植术后血管危象发生的独立预测因素。术中根据具体伤情决定合适的静脉回流方式,术后加强抗凝治疗及对高危人群的观察对预防末?
Objective To determine the main predictors of circulatory crisis after replantation in patients with severed distal finger so as to establish the theoretic basis in reducing the morbidity of circulatory crisis. Methods 65 severed distal fingers underwent replantation were respectively reviewed. All the clinical parameters including age, sex, dominant hand or finger, preservation of the severed finger, platelet level, ischemia duration, cause of injury, manner of venous drainage, repair of artery, order of reparation and plane of division were investigated as predictive risk factors for circulatory crisis of finger after replantation. In order to find the risk factors of circulatory crisis, the data was dealt with t test, χ2 test, analysis for variance or multivariate Logistic regression analysis. Results 13 replanted finger suffered from impaired circulation in 65 fingers. Univariate analysis demonstrated that many factors were significantly correlated with the circulatory crisis of finger, such as the manner of venous drainage(χ2=6.714,P=0.035), the cause of injury (χ2=9.049,P=0.011), the preservation of severed finger(χ2=6.452,P=0.040), the age(χ2=14.838,P=0.001), the platelet level(uc= 2.961, P=0.003). The multivariate Logistic regression analyses showed that platelet level (OR=1.015, P=0.030), the age(OR=0.349, P=0.031) and the manner of venous drainage(OR=0.278,P=0.036) were the significant independent predictors for circulatory crisis. The incidence of circulatory crisis in patients less than 6 years old was 61.5%, significantly higher than any other age group(P<0.05) and the incidence in patients with drainage only by venous anastomosis was 43.8%, also obviously higher than any other method group (P<0.01). Conclusion Circulatory crisis of amputated finger after replantation is dominated by age, platelet level and the manner of venous drainage. With appropriate venous drainage determined by lesion condition, the use of anticoagulation and close observation of high-risk group are essential to prevent circulatory crisis, and may improve the outcome after replantaion of distal finger.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2004年第8期478-481,共4页
Chinese Journal of Orthopaedics
