遠端指節斷指再接術－－澄清醫院的經驗

Distal Phalanx Replantation: Experience of Cheng-Ching Hospital

澄清醫院平等院區很早之前就已經開始在做遠端指節斷指再接的顯微手術了。我們搜集從1998年5月到2004年5月，91位患者，共102隻遠端指節或遠端指間關節完全截斷的手指，重新再接後的資料，做個整體的回顧。因爲外型的完整和功能的需要，對社會一般大眾仍然存在著很高的價値。所以，連那些斷指有著嚴重的軟組織損傷的患者，我們也盡量選擇斷指再接術來治療。結果顯示，總存活率達到85.3％。斷在zone I區域的存活率達到76.2％，而斷在zone II區域的存活率更達到了91％。甚至對那些合併有嚴重的手指壓砸傷或掀脫傷的患者而言，斷指再接後的存活率也是相當高的。資料中的52位成功接回的患者之中，有40位重新回到了他們原來的工作崗位上，只有3位無法回到原來的工作，另外2位是學生，7位因爲斷了太多手指而離職。我們覺得接受斷指再接手術是很値得的。患者不管在外觀上和功能上的滿意度，都是相當高的。

Microsurgical replantation has been attempted in the distal phalanx of the digits at Ping-Tien Branch Cheng-Ching Hospital. From May 1998 to May 2004, 102 digits in 91 patients with complete amputations at or distal to the distal interphalangeal joint were reviewed. Because of the high social value placed on body form and function, the indication for replantation was extended to cases with severe soft-tissue injuries and as a routine procedure in nearly distal phalanx amputation cases. The over all survival rate was 85.3 percent, with the survival rate for zone I being 76.2 percent and that for zone II reaching 91 percent. Even in cases with severe crush or avulsion injury, the survival rate was high. 40 of 52 patients returned to their original work. Only 3 cases changed their job. We feel that distal digital replantation is rewarding. Patients’ satisfaction, aesthetically and functionally, is high.