The Functional Recovery of a Guillotine-Type Amputation of Arm after Replantation-A Case Report

斷頭式上臂重植後之功能恢復－病例報告

陳秀萍(Shiou-Ping Chen) ； 陳伊呈(I-Chen Chen) ； 林雍球(Yung-Chiu Lin) ； 顏榮信(Jung-Hsing Yen) ； 歐令奮(Ling-Feng Ou) ； 唐友文(Yu-Wen Tang)

《中華民國整形外科醫學會雜誌》 13卷1期 (2004/03) Pp. 51-58

https://doi.org/10.7096/JPSA.200403.0051

摘要

我們提出一例斷頭式上臂截肢，重植三年後的功能恢復。一位31歲男性，右手上臂中段於工作時意外被電鋸鋸斷，其斷肢在4小時20分鐘後回復血液供給。2年後其手部內在肌肉的回復卻很少，病人於上臂重植兩年三個月後接受肌腱轉移手術，用以回復對掌功能及矯正瓜形手畸形。並於八個月後再次手術，將姆指肌腱拉力方向予以改變。
病人的肘關節活動度為150度，腕關節為140度，姆指的總關節活動度為100度，其他手指的總關節活動度為170至260度。病人手部回復保護性感覺，滿意的功能及外觀。以Tamai功能評估表評估，重接斷肢達到65分，以Chen's criteria評估達到第二至第三級功能恢復。
在合適的情形下，上臂截肢應盡量嘗試重植，同時可再加做其他手術來改善手部功能。

並列摘要

We reported the functional recovery of an amputated arm 3 years after replantation. A 31-year-old male sustained a guillotine-type amputation of his right arm at the mid-humeral level during working. Replantation procedures were undertaken smoothly and the circulation of amputee restored within 4 hours and 20 minutes of total ischemia. The recovery of intrinsic muscles was minimal through two years follow-up. To improve finger function, the patient underwent opponensplasty and dynamic intrinsic tenodeses 2 years and 3 months post-operation. Revision opponensplasty was performed 8 months later due to inadequate correction of opposition.
The patient regained 150° range of motion on the elbow and 140° on the wrist. The total active movement of the thumb was 100°. The total active movement of other fingers was from 170° to 260°. The patient regained a successfully replanted arm, which was sensate and functional with a satisfactory appearance. The replanted limb achieved good result with 65 Tamai score, which corresponded to grade Ⅱ-Ⅲ functional result as classified by the Chen's criteria.
Arm replantation under ideal situation should be attempted. The inadequate functional recovery of the hand can be further improved with secondary procedures.

並列關鍵字

guillotine-type amputation of arm ； functional recovery ； replantation ； tendon transfer