Application Of Leech After Replantation Of Severed Finger

Objective:To explore the effect of leech on anticoagulation and prevention of vascular crisis after replantation of severed finger.Methods:(1)According to the inclusion and exclusion criteria,200 inpatients with complete amputation of single or multiple fingers were selected from the Department of Orthopedics and Traumatology,Affiliated Hospital of Traditional Chinese Medicine,Southwest Medical University,from January2021 to December 2022.The patients were divided into control group and study group by drawing lots,that is,100 cases in control group and 100 cases in study group.The control group was treated with conventional anticoagulation,anti-vasospasm,anti-infection and visible light irradiation;On the basis of conventional anticoagulation,anti-vasospasm and anti-infection,the study group took leech orally for 3 g/day for 7 consecutive days;⑵ The population composition,finger injury and clinical observation indexes of replanted fingers(including blood supply,color,skin temperature,capillary filling time and swelling degree of replanted fingers)were collected from the two groups;Collect and compare the coagulation function index,hemorheology index,related inflammatory reaction index and the functional recovery of 2 months before and after operation;To compare the effectiveness of leech in anticoagulation and prevention of vascular crisis after replantation of severed finger.⑶ All data were statistically analyzed using SPSS22.0 software α= 0.05 is the inspection standard,when P value is less than 0 At 05:00,the difference was statistically significant.Results:(1)In the study group(group A),there were 100 patients with 115 root fracture index,of which 60 were male patients with severed fingers,accounting for 60%,and 40 were female patients with severed fingers,accounting for 40%.The age ranged from 18 to 65 years old,with an average age of 38.56 ± 9.44 years.The location and plane of severed fingers: 6 cases(5.22%)of proximal segment of thumb and 15 cases(13.04%)of distal segment of thumb;The proximal segment of the index finger was severed in 5 cases(4.35%),the middle segment in 6 cases(5.22%),and the distal segment in 12cases(10.43%);The proximal segment of the middle finger was severed in 3cases(2.61%),the middle segment in 6 cases(5.22%),and the distal segment in13 cases(11.30%);The proximal segment of ring finger was severed in 4 cases(3.48%),the middle segment in 8 cases(6.96%),and the distal segment in 15cases(13.04%);The proximal segment of the little finger was severed in 3cases(2.61%),the middle segment of the little finger in 6 cases(5.22%),and the distal segment of the little finger in 13 cases(11.30%).⑵ In the control group(group B),there were 120 severed fingers in 100 patients,including 62 male severed fingers,accounting for 62%,and 38 female severed fingers,accounting for 38%.The age ranged from 18 to 65 years old,with an average age of 40.37 ± 9.63 years.The location and plane of the severed finger: 5 cases(4.17%)of proximal segment of thumb and 16 cases(13.33%)of distal segment of thumb;The proximal segment of the index finger was severed in 6 cases(5.00%),the middle segment in 7 cases(5.83%),and the distal segment in 13cases(10.83%);The proximal segment of the middle finger was severed in 4cases(3.33%),the middle segment in 8 cases(6.67%),and the distal segment in14 cases(11.67%);The proximal segment of the ring finger was severed in 3cases(2.50%),the middle segment in 9 cases(7.50%),and the distal segment in15 cases(12.50%);The proximal segment of the little finger was severed in 2cases(1.67%),the middle segment of the little finger in 5 cases(4.17%),and the distal segment of the little finger in 13 cases(10.83%).⑶ There is no statistically significant difference between the population composition of the two groups(Group A)and the control group(Group B).⑷ The temperature of replanted fingers in the study group was higher than that in the control group on the 3rd and 7th day after operation(P<0.05).(5)There was no statistically significant difference between the two groups in preoperative prothrombin time(PT),prothrombin time international normalized ratio(INR),activated partial thromboplastin time(APTT),fibrinogen(FIB),and thrombin time(TT)(P>0.05).On the seventh day after operation,the prothrombin time,activated partial thromboplastin time and thrombin time of both groups were prolonged,the international standardized ratio of prothrombin time increased,and fibrinogen increased.There was statistically significant difference between the two groups in the indexes of coagulation function on the seventh day after operation(P<0.05).(6)There was no significant difference between the two groups in high shear viscosity,low shear viscosity,plasma viscosity and hematocrit before and on the first day after operation(P>0.05).On the seventh day and two weeks after operation,the whole blood high shear viscosity,low shear viscosity,plasma viscosity and hematocrit of the two groups after replantation of severed fingers were significantly lower than those before operation(P<0.05).There was a statistically significant difference between the study group and the control group(P<0.05).(7)There was no statistically significant difference between the study group and the control group in preoperative white blood cell count(WBC),C-reactive protein(CRP)and procalcitonin(PCT).The quantitative analysis of white blood cell count(WBC),C-reactive protein(CRP)and procalcitonin(PCT)in the study group on the seventh day after operation was lower than that in the control group,and the difference was not statistically significant(P>0.05).(8)The incidence of vascular crisis after replantation of severed fingers in the study group and the control group was 6.96% in Group A and 13.04% in Group B,the difference was statistically significant(P<0.05).(9)The survival rate of replanted fingers between the two groups was 95.65% in group A and 90.83% in group B,the difference was statistically significant(P<0.05).(10)There were no gastrointestinal reactions(nausea,vomiting,abdominal pain,diarrhea),upper gastrointestinal bleeding(hematemesis,black stool)and allergic reactions in both groups.(11)The rehabilitation of finger body function of patients 2months after operation: 104 excellent fingers in the study group and 90 excellent fingers in the control group,with statistical difference between the two groups(P<0.05).Conclusion:Leech has a strong anticoagulant effect,which can reduce the occurrence of vascular crisis after replantation of severed fingers and improve the survival of replanted fingers.