| Objective:The single vein anastomosis in severed finger replantation combined with postoperative application of Salvia miltiorrhiza ligustrazine injection were used to treat single severed finger with serious injury and poor vascular conditions,and compared with the clinical efficacy of multi-vein anastomosis in severed finger replantation,which could provide ideas for improving the clinical treatment of some patients with severe severed finger injury.Methods:159 patients who underwent replantation of single severed finger according to the inclusion criteria were selected from January 2014 to December 2018.The patients were divided into group A,B and C according to different treatment schemes.In group A,50 patients underwent single vein anastomosis during finger replantation;In group B,53 patients underwent single vein anastomosis during finger replantation and postoperative intravenous drip of 10 ml Salvia miltiorrhiza ligustrazine injection;in group C,56 patients underwent multi-venous anastomosis during finger replantation.All operations were performed by doctors in the same group.All patients were treated with anti-infection,anticoagulant and antispasmodic.The main outcome measures were:the severed finger survived;operation time and postoperative hospital stay（LOS）;VAS pain scores before operation,2 days after operation,the day of discharge and 3 years after operation;the standard score of the function evaluation of severed finger replantation of the society of hand surgery of Chinese Medical Association at 3 months,6 months,1 year and 3 years after operation;distal interphalangeal joint range of motion（DIPJ）at 3 months,6 months,1 year and 3 years after operation;two point discrimination（2PD）at 3 months,6 months,1 year and 3 years after operation.Moreover,the complications and adverse reactions such as early postoperative wound infection,vascular crisis,wound bleeding and constipation,as well as late postoperative complications such as tendon adhesion,joint stiffness and skin necrosis around fingers were observed.Result:1.The survival rate of severed fingers:42 patients in group A survived and 8 failed,with a success rate of 84%.47 cases in group B survived and 6 failed,with a success rate of 89%.52 cases in group C survived and 4 failed,with a success rate of 93%.There was no significant difference in the survival of severed fingers among the three groups（P>0.05）,but the survival rate of group C was higher than that of group A and group B,and the survival rate of group B was higher than that of group A.2.Operation time:the operation time of group B was 2.57±1.13h,which was no statistically significant difference compared with group A（2.52±1.24h）（P>0.05）;the operation time in group C was longer（3.45±1.49h）than those of group A and group B,and the difference was statistically significant（P<0.05）.3.VAS pain score:There was no significant difference in VAS pain score before operation and 3 years after operation among the three groups（P>0.05）;Compared with group A and group C,the VAS pain score of group B was significantly lower at 2 day after operation and the day of discharge（P<0.05）.There was no significant difference in VAS pain score between group A and group C.4.The trial standard score of the function evaluation of severed finger replantation of the hand surgery society of the Chinese Medical Association:the standard score of in group B and group C were significantly higher than that in group A at 3 months,6 months,1 year and 3 years after operation（P<0.05）;Compared with group B,there was no significant difference in the trial standard score in group C at 3 months,6 months,1 year and 3 years after operation（P>0.05）.5.The distal interphalangeal joint range of motion（DIPJ）:the distal interphalangeal joint range of motion（DIPJ）in group B and group C increased significantly compared with group A at 3 months,6 months,1 year and 3 years after operation（P<0.05）;there was no significant difference in distal interphalangeal joint range of motion（DIPJ）between group B and group C at 3 months,6 months,1 year and 3 years after operation（P>0.05）.6.The two-point resolution（2PD）:the two-point resolution（2PD）in group B and group C increased significantly compared with group A at 3 months,6 months,1 year and 3 years after operation（P<0.05）;there was no significant difference in two-point discrimination（2PD）between group B and group C at 3 months,6 months,1 year and 3 years after operation（P>0.05）.7.Complications:there were 11 patients with vascular crisis in group A and the incidence rate was 22%;there were 7 cases in group B and the incidence was 13%;there were 8 cases in group C and the incidence was 14%.There was no significant difference in postoperative complications such as infection,bleeding,constipation,tendon adhesion and joint stiffness among the three groups（P>0.05）.Compared with group A,skin necrosis in group B and group C was significantly reduced（P<0.05）.Conclusion:The single vein anastomosis combined with postoperative application of Salvia miltiorrhiza ligustrazine injection were used to treat single severed finger with serious injury and poor vascular conditions,which can improve the survival rate of severed fingers,effectively reduce postoperative pain,promote the recovery of finger sensory and motor functions,as well as reduce the incidence of postoperative vascular crisis and skin necrosis. |
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