末节断指再植重建供血新方法-指侧方静脉动脉化  

A new method of veno-arteriolization of finger lateral vein reconstruction of blood supply for repairing severed finger tips

作　　者：江起庭 杨丽娜 王钰[2] 江志伟[3] 

机构地区：[1]巢湖紫晨手外科医院手外科中心,238000 [2]沈阳医学院附属中心医院沈阳市手外科研究所,110024 [3]南京军区南京总医院全军普外科研究所,210002

出　　处：《中华损伤与修复杂志（电子版）》2014年第3期24-28,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：江苏省科技计划重点资助项目(BS2007054);南京军区科技创新重点资助项目(07Z028)

摘　　要：目的通过与传统指腹静脉动脉化再植比较,探讨指侧方静脉动脉化重建供血再植末节断指的可行性及疗效。方法将2006年3月至2013年1月巢湖紫晨手外科医院手外科中心收治并符合选择标准的39例(39指)末节断指患者纳入研究,均为正常指动脉多次吻合失败后行静脉动脉化。将患者采用随机数字法分为两组,20例患者采用指侧方静脉动脉化再植(试验组),用近端指动脉与远端指侧方静脉吻合;19例患者采用指腹静脉动脉化再植(对照组),用近端指动脉与远端指腹静脉吻合。两组患者在性别、年龄、致伤原因、病程、损伤指别、末节分型、动脉吻合失败次数及骨折、神经损伤方面比较,差异均无统计学意义(P>0.05),具有可比性,重点比较两组术后的成活率、指甲长度、两点辨别觉、远端指间关节(DIPJ)活动度、手指感觉、手指各关节活动度测定。结果术后试验组再植指成活率100%(20/20)与对照组成活率为78.9%(15/19)相比,差异有统计学意义(χ2=8.155,P=0.038)。试验组再植指均外形佳,指甲生长近平整;对照组再植指均出现轻度萎缩,指甲生长均不平整。术后6个月试验组再植指指甲长度(15.6±2.7)mm、DIPJ活动度(62±4)°及手指感觉(S3+)、两点辨别觉(4.6±0.3)mm均优于对照组,差异有统计学意义(P<0.05)。手指各关节活动度参照总主动活动度评价标准:试验组优良率(94.4%)与对照组优良率(77.8%)比较,差异有统计学意义(χ2=6.889,P=0.032)。结论指侧方静脉动脉化有效克服了指腹静脉动脉化的解剖局限性,能提高再植指成活率,促进指甲生长及感觉恢复,增强DIPJ活动度,为正常供血多次失败后的末节断指提供了一种有效的补救方法。Objective To explore the effectiveness of veno-arteriolization of finger lateral vein for repairing severed finger tips by comparing with veno-arteriolization of finger pulp vein. Methods From March 2006 to January 2013, 34 patients with severed finger tips were admitted to zichen hand surgery hospital of chaohu, with veno- arteriolization after failure in anastomosing artery of finger over times. Twenty patients underwent veno-arteriolization of finger lateral vein （20 fingers, trial group）. During operation, the digital artery proximal end and the finger lateral vein distal end were anastomosed as the route of blood supply. Fourteen patients underwent veno-arteriolization of finger pulp vein（ 19 fingers, control group）, the digital artery proximal end and the finger pulp vein distal end were anastomosed as the route of blood supply. There was no significant difference in gender, age, cause of injury, duration of disease, finger of injury, lesion segments, failure in anastomosing artery of finger over times, fracture, and nerve damage between the two groups （P 〉 0.05 ）. Results All patients survived completely in trial group, the survival rate was 100% （20/20） ; 4 fingers necrosis in control group, the survival rate was 78.9% （15/19） ; there were significant difference in results between 2 groups（χ^2 = 8. 155, P = 0. 038）. The fingers had satisfactory appearance, finger pulp was plump with good flexibility, no obvious deformed growth of nail were found, and a sound recovery was obtained in trial group ; mild atrophy of the fingers in control group. The postoperative length of nail, motion of distal interphalangeal joint, sensation measuremen, and two point discrimination were improved significantly when compared with preoperative values in the two groups （ P 〈 0.05 ）. According to total active movement scales, the results were excellent in 12 cases, good in 5 cases and fair in 1 cases, with an excellent and good rate of 94.4 in trial group ; the results were excellent in 5 cases,

关 键 词：静脉动脉化 修复外科手术 断指再植 

分 类 号：R658.1[医药卫生—外科学]