骨科英文书籍精读（173）｜手外伤（12）
Replantation
With modern microsurgical techniques and appropriate skill, amputated digits or hands can be replanted. An amputated part should be wrapped in sterile saline gauze and placed in a plastic bag, which is itself placed in watery ice. The ‘cold ischaemic time’ for a finger, which contains so little muscle, is about 30 hours, but the ‘warm time’ less than six. For a hand or forearm, the cold ischaemic time is only about 12 hours and the warm time much less. After resuscitation and attention to other potentially life-threatening injuries, the patient and the amputated part should be transferred to a centre where the appropriate surgical skills and facilities are available.
INDICATIONS
The decision to replant depends on the patient’s age, his or her social and professional requirements, the condition of the part (whether clean-cut, mangled, crushed or avulsed), and the warm and cold ischaemic time. Furthermore, and perhaps most importantly, it depends on whether the replanted part is likely to give better function than an amputation.
The thumb should be replanted whenever possible. Even if it functions only as a perfused ‘post’ with protective sensation, it will give useful service. Multiple digits also should be replanted, and in a child even a single digit. Proximal amputations (through the palm, wrist or forearm) likewise merit an attempt at replantation.
RELATIVE CONTRAINDICATIONS
Single digits do badly if replanted. There is a high complication rate, including stiffness, non-union, poor sensation, and cold intolerance; a replanted single finger is likely to be excluded from use. The exception is an amputation beyond the insertion of flexor digitorum superficialis, when a cosmetic, functioning finger-tip can be retrieved. Severely crushed, mangled or avulsed parts may not be replantable; and parts with a long ischaemic time may not survive. General medical disorders or other injuries may engender unacceptable risks from the prolonged anaesthesia needed for replantation.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
wrap/ræp/vt. 包；缠绕
sterile /ˈsterəl/adj. 不育的；无菌的；贫瘠的；不毛的；枯燥乏味的
gauze /ɡɔːz/n. 纱布；薄纱；薄雾
saline /ˈseɪliːn/n. 盐溶液；生理盐水adj. 盐的，含盐的；咸的；含氯化钠的；含镁盐类的；含碱金属盐类的
ischaemic adj. 局部缺血的
resuscitation /rɪˌsʌsɪˈteɪʃn/n. 复苏；复兴；复活
mangle /ˈmæŋɡl/割碎 撕裂 乱砍
crush /krʌʃ/v. 压坏，压扁
avulse /əˈvʌls/v. 抽出；撕裂，撕脱
likewise merit an attempt at replantation. 同样值得尝试再植。
likewise /ˈlaɪkwaɪz/adv. 同样地；也
merit /ˈmerɪt/n. 优点，价值；功绩；功过vt. 值得
be excluded from use不能使用
exception /ɪkˈsepʃn/n. 例外；异议
retrieve /rɪˈtriːv/n. [计] 检索；恢复，取回vt. [计] 检索；恢复；重新得到
engender /ɪnˈdʒendər/vt. 使产生；造成vi. 产生；引起
百度翻译：
再植
利用现代显微外科技术和适当的技术，可以对断指或手进行再植。截肢的部分应该用无菌盐水纱布包好，放在一个塑料袋里，塑料袋本身就放在冰水里。手指的“冷缺血时间”约为30小时，但“温暖时间”不到6小时。对于手或前臂，冷缺血时间只有12小时左右，而温暖时间要少得多。在复苏并注意到其他可能危及生命的损伤后，应将患者和截肢部分转移到具备适当外科技能和设施的中心。
适应症
再植的决定取决于患者的年龄，他或她的社会和专业要求，部分的状况（无论是干净的切，损伤，压碎或撕脱），以及热缺血和冷缺血时间。此外，也许最重要的是，这取决于再植部分是否比截肢功能更好。
拇指应尽可能地再植。即使它只是一个充满保护感的“帖子”，它也会提供有用的服务。多发性指骨离断也应该再植，而且在一个孩子甚至一个位数。近端截肢（通过手掌、手腕或前臂）同样值得尝试再植。
相对禁忌症
如果再植的话，个位数做得不好。并发症发生率高，包括僵硬、不愈合、感觉不良和冷不耐受；单指再植可能会被排除在使用之外。例外情况是指浅屈肌插入以外的截肢，当一个美容的，功能性的指尖可以恢复。严重压碎、损伤或撕脱的部分可能无法再植，并且长时间缺血的部分可能无法存活。一般的内科疾病或其他损伤可能会因再植所需的长时间麻醉而产生不可接受的风险。