Hand Replantation without Proximal Row Carpectomy-A Case Report

保留近排腕骨之斷掌重接－病例報告

鐘一傑(Yi-Chien Chung) ； 鄧修國(Hsiu-Gwo Teng) ； 吳瑞星(Simon Jui-Hsing Wu) ； 顏仲毅(Chung-Yih Yan)

《臺灣整形外科醫學會雜誌》 20卷2期 (2011/06) Pp. 129-135

https://doi.org/10.7096/TJTSPS.201106.0129

摘要

背景：
對於腕部截肢重接後的功能性評估的相關文獻不多。大部份的腕部截肢重接術需將近排腕骨切除。
目的及目標：
我們提出一病例報告，保留近排腕骨之腕部截肢重接，術後追蹤二年並進行功能性評估。
材料及方法：
一位十八歲男性因外傷導致左手腕部截斷。X光片顯示了近排腕骨處之斷頭台式截肢。骨科醫師在傷口清創後保留近排腕骨，直接進行腕骨固定。術中重要結構的吻合順序如下：橈動脈、尺動脈、背側靜脈三條、屈肌肌腱、正中神經、尺神經、伸肌肌腱及橈神經皮枝。術中沒有使用靜脈或神經移植。
結果：
術後恢復過程順利，六星期後開始復健。術後二年的追蹤：腕關節主動活動度達75度，手指的總主動活動度達正常對側之76%。病人可從事大部分的日常活動。
結論：
斷掌重接是值得努力的，功能可以恢復不錯。若是斷頭台式的腕部截肢，不一定需要做近排腕骨切除術。術後復健也是相當的重要。

並列摘要

Background:
There are few reports on the functional results following complete hand amputations at the wrist joint. Most cases of wrist level complete amputation are replanted following proximal row carpectomy.
Aim and Objectives:
We present a Guillotine type amputated hand replanted without proximal row carpectomy. The functional result was assessed at 2-year follow-up.
Materials and Methods:
An 18-year-old male patient suffered left wrist amputation. The X-ray showed a Guillotine type amputation at proximal row of carpal bones. After debridement, orthopedic surgeons performed carpal bones fixation without proximal row carpectomy. The sequence of the anastomosis was as follows: radial artery, ulnar artery, three dorsal veins, flexor tendons except palmaris longus tendon, median nerve, ulnar nerve, extensor tendons and superficial branch of the radial nerve. No vein graft or nerve graft was utilized.
Results:
The post-operative course of the replantation was uneventful. Rehabilitation started at post-op 6 weeks post-operatively. At 2-year follow-up, wrist active range of motion (ROM) of the wrist achieved 75 degrees. Total active motion (TAM) score for digital flexion and extension was 76%. The patient could perform most daily tasks, the functional evaluation results was Level II (good). Intrinsic muscle function was markedly impaired, however, no specific postural change was observed postoperatively.
Conclusion:
Replantation following wrist amputation is extremely worthwhile for good potential functional recovery. Proximal row carpectomy may not be necessary if guillotine type amputation is observed. Orthopedic rehabilitation is also important for better outcome.

並列關鍵字

guillotine type amputation ； hand replantation ； proximal row carpectomy