指尖横形离断伤的分型及修复方法探讨

中国修复重建外科杂志2008年9月第22卷第9期·1089·指尖横形离断伤的分型及修复方法探讨

周晓 许亚军 芮永军 姚群

【摘 要】 目的 探讨指尖横形离断伤新的分型和修复方法。 方法 2000年3月－2006年10月，收治20例

指尖横形离断伤。男13例13指，女7例7指；年龄17～47岁。挤压伤9例，切割伤5例，电锯伤6例。指尖横形离断

伤分为4型：Ⅰ型为甲床远1/3平面，Ⅱ型为甲床中段平面，Ⅲ型为甲床近1/3平面，Ⅳ型为甲根平面。Ⅰ型中示指2例，

小指1例；Ⅱ型中拇指2例，示指、中指各3例；Ⅲ型中示指3例，环指、小指各1例；Ⅳ型中拇指2例，中指、小指各1例。

缺损范围1.2 cm × 1.2 cm～1.5 cm × 1.2 cm。伤后至手术时间3～10 h。其中Ⅰ、Ⅱ型应用带血管神经束顺行岛状皮瓣，并行改良甲床扩大术；Ⅲ、Ⅳ型应用带血管神经束顺行岛状皮瓣与甲床回植，行改良甲床扩大术。术中皮瓣切取范围1.5 cm × 1.2 cm ～2.0 cm × 1.4 cm。 结果 术后皮瓣及甲床均成活，切口Ⅰ期愈合。供区植皮均成活，创面Ⅰ期愈合。患者均获随访，随访时间2～6个月，平均4个月。皮瓣外形饱满、质软，肤色和皮温均正常，两点辨别觉4.5～6.5 mm。Ⅰ、Ⅱ型患指指甲较术前延长3 ～4 mm；Ⅲ、Ⅳ型患指指甲较术前延长8 ～10 mm。1例术后6个月出现钩甲畸形，未作

处理。指甲光滑、无压痛，甲床平整无甲棘；患指各关节活动无影响。 结论 对指尖离断伤损伤平面进行分型后采用不

同的修复方法，有利于最大程度恢复指尖功能和外形。

【关键词】 指尖离断 分型 岛状皮瓣 甲床回植 甲床扩大

中图分类号： R658.2 R622 文献标志码：A

INVESTIGATION OF NEW CLASSIFICATION AND REPAIR METHODS FOR FINGERTIP TRAVERSE AMPUTATION/ZHOU Xiao, XU Yajun, RUI Yongjun, YAO Qun. Wuxi Hand Surgery Hospital, Wuxi Jiangsu, 214061, P.R.China. Corresponding author: ZHOU Xiao, E-mail: zhoudaxiao@

【Abstract】Objective To investigate new classification and repair methods for the traverse amputated fingerti p. Methods From March2000to October2006,20cases of20fingers with traverse amputated fingerti p,including

13males and7females aged17-47 years,were treated.Twenty patients(9crush injuries,5cutting injuries and6sawing injuries) were classified into4types, namely type I(the distal one third of nail bed),type II(the middle of nail bed),type III(the poximal one third of nail bed),and type IV(the root of nail bed).There were3patients(2index fingers and1little finger)of type I,

8patients(2thumbs,3index fingers and3middle fingers) of type II,5patients(3index fingers,1ring finger and1little finger)

of type III,and4patients(2thumbs,1middle finger and1little finger)of type IV. The soft tissue defect ranged from1.2cm ×1.2cm to1.5cm × 1.2cm.The time from injury to surgery was3-10hours.Fingers of type I and type II were treated with forward flow axial flap and modified nail bed lengthening.Fingers of type III and type IV were treated with forward flow axial flap and partial nail bed replantation as well as modified nail bed lengthening.The flaps ranged in size from1.5cm × 1.2cm to 2.0cm × 1.4cm.Results Twenty patients incisions healed by first intention and the flaps,nails and skin grafting survived.All donor sites healed by first intention.All patients were followed up for2-6months(4months on average).The appearances of fingertips were good.The texture of the flap was soft,and the fingers had no tenderness and motor disturbance.The two-point discrimination was4.5-6.5mm．The finger nails of type I and type II extended3-4mm after operation,while the finger nails of type III and type IV extended8-10mm after operation.All finger nails were smooth and flat without pain.Hook nail happened in

1case6months after operation.Conclusion Classification of the injured fingers according to the condition of the amputation base is helpful in choosing repair methods,and is conducive to maximize the recovery of the function and shape of fingertips.

【Key words】 Fingertip amputation Classification Island flap Nail bed replantation Nail bed expansion

指尖是甲根以远的手指末梢部分，该部分横形离断以压砸伤常见，由于离断指体毛细血管床严重破坏或指尖血管纤细，无法试行再植[1-3]。指尖离断多伴甲床不同平面缺失，如处理不当会影响指尖外形和功

作者单位：无锡市手外科医院（江苏无锡，214061）

通讯作者：周晓，主治医师，研究方向：手外科、显微外科，E-mail: zhoudaxiao@ 能。2000年3月－2006年10月，我们根据指尖离断平面的不同，对20例指尖离断伤患者采用不同的修复方法，取得良好效果。报告如下。

1 临床资料

1.1 一般资料

本组男13例13指，女7例7指；年龄17～47岁，