仅吻合指动脉终末支指尖再植的临床评价及流体力学分析  

Clinical evaluation and hemodynamics analysis of fingertip replantation with anastomosis of digital artery terminal branch only

作　　者：周望高[1] 陈乐锋[1] 余少校[1] 李征[1] 陈国荣[1] 熊懿[1] 陈泽华[1] 白印伟[1] 柯于海[1] 张振伟[1] 

机构地区：[1]广州医科大学附属深圳沙井医院手外科,518104

出　　处：《中华手外科杂志》2014年第4期283-285,共3页Chinese Journal of Hand Surgery

基　　金：广东省医学科研基金项目（项目编号B2011298）

摘　　要：目的 探讨仅吻合指动脉终末支指尖再植的侧支回流的流体力学机制.方法 2009年9月至2013年3月,对58指指尖离断病例进行再植,术中仅吻合1条指动脉终末支,注意保留指动脉弓的完整性和吻合口近端的分支,术后不做甲床放血和小切口放血.结果 58指指尖再植病例中存活55指,坏死3指;成活率为94.8％.术后随访3～ 12个月（平均7.8个月）,存活指体饱满,指甲生长良好,外形满意,静态两点分辨觉为3～7mm.结论 仅吻合指动脉终末支指尖再植的成功率高,保留指动脉弓的完整性,能提供有效的分流,用流体力学的伯努利定理（P＋ 1/2 ρv2＋ ρgh＝常量）分析指尖再植指动脉侧支回流现象,指动脉吻合口近端的侧支能提供侧支回流,这种现象是吻合单根血管指尖再植存活的主要机制.Objective To investigate the hemodynamics of collateral flow in fingertip replantation with anastomosis of digital artery terminal branch only.Methods From September 2009 to March 2013,replantation of 58 severed fingertips was carried out.Intraoperative only one terminal branch of the digital artery was anastomosed.Care was taken to preserve the integrity of the digital artery arch and the branches proximal to the anastomotic site.Neither nail bed bleeding nor small incision bleeding was done postoperatively.Results Among the 58 replants,55 fingertips survived while 3 were lost due to necrosis,the survival rate being 94.8％.Postoperative follow-up period ranged from 3 to 12 months （average,7.8 months）.The survived fingertips were full,with normal growing nails and good appearances.Static two-point discrimination was 3 to 7 mm.Conclusion High survival rate can be achieved in fingertip replantation with anastomosis of one digital artery terminal branch only.Preserving the arterial arch provides sufficient collateral flow.Analysis of the collateral flow in the replanted finger using Bernoulli＇s Law （P ＋ 1/2 ρg2 ＋ ρgh =constant） of hemodynamics shows that collateral branches proximal to the anastomosis can provide collateral drainage.This is the main mechanism for the survival of replanted fingertips when only one terminal branch of the digital artery is anastomosed.

关 键 词：傅里叶分析 再植术 侧支 分流 

分 类 号：R658.1[医药卫生—外科学]