两种指侧方静脉动脉化的回顾性研究  

Retrospective studies of two veno-arteriolization of finger lateral vein

作　　者：江起庭 盖晓伟 郑建仁 吴李峰 丁子晗 杨传金 杨丽娜 

机构地区：[1]南京邦德骨科医院手足外科,江苏南京210018 [2]巢湖紫晨手外科医院手外科中心,安徽巢湖238000

出　　处：《实用手外科杂志》2015年第2期126-129,165,共5页Journal of Practical Hand Surgery

基　　金：南京军区科技创新重点资助项目（072028）;江苏省科技计划重点资助项目（BS2007054）

摘　　要：目的 回顾两种指侧方静脉动脉化再植末节断指的临床疗效. 方法 2011年2月—2013年6月收治断指患者37例,均在正常指动脉多次吻合失败后行指侧方静脉动脉化. 20例采用双动脉式指侧方静脉动脉化再植,将非优势侧指固有动脉近端端侧吻合于优势侧指固有动脉上,然后将优势侧动脉的近端与指侧方静脉远端吻合.17例采用单式指侧方静脉动脉化再植,直接将优势侧动脉近端与指侧方静脉远端吻合. 结果 双动脉式指侧方静脉动脉化组病例全部成活,创面均一期愈合;单式指侧方静脉动脉化组6例坏死.除坏死指外所有病例（31例）均在术后获4~8个月,平均（6.2±1.6）个月随访.双动脉式指侧方静脉动脉化组20例,指外形好,指腹饱满,指体无萎缩;指甲生长平整,长度（14.8±4.1） mm,长于另一组;两点分辨觉（4.8±0.7） mm,小于另一组;感觉测定为S（3.55±0.45）级,高于另一组;DIPJ活动度为（57 ± 5）°,大于另一组.参照Tamai评分标准评定：优12,良8例,优良率100%.单式指侧方静脉动脉化组11例,指体轻度萎缩;指甲生长不平整,长度（10.1±0.8） mm;两点分辨觉（7.3±0.5） mm;感觉测定为S（2.36±0.22）级;DIPJ活动度为（44±3）°.参照Tamai评分标准评定：优2例,良5例,可3例,差1例,优良率63.6%. 结论 双动脉式指侧方静脉动脉化放大了单式指侧方静脉动脉化作用,迅速使静脉瓣膜无创伤性失效,提高再植指成活率,促进指甲生长及感觉恢复,增强指关节活动度,为正常供血多次失败后的断指提供了一种有效的补救方法.Objective Retrospective effect of two veno-arteriolization of finger lateral vein for repairing distal severed fingers. Methods From February 2011 to June 2013, 37 patients with distal severed fingers were admitted to our center, with veno-arteriolization of finger lateral vein after failure in anastomosing artery of finger over times. 20 patients underwent veno-arteriolization of finger lateral vein with bilateral proper digital artery. During operation, the non-superiorty digital artery had been end -to -side anastomosed with the dominant digital artery, then the dominant digital artery proximal end and the finger lateral vein distal end was anastomosed as the route of blood supply. 17 patients underwent veno-arteriolization of finger lateral vein with single proper digital artery, the dominant digital artery proximal end and the finger lateral vein distal end was directly anastomosed as the route of blood supply. Results All patients survived completely and achieved primary healing of wound after operation in veno-arteriolization of finger lateral vein with bilateral proper digital artery group; 6 fingers necrosis in veno-arteriolization of finger lateral vein with single proper digital artery group. 31 patients were successfully followed up for 4 to＆amp;nbsp;8 months, with an average of（6.2±1.6） months. In veno-arteriolization of finger lateral vein with bilateral proper digital artery group, 20 patients were successfully followed up, the fingers had satisfactory appearance, finger pulp was plump with good flexibility, no obvious deformedgrowth of nail were found, and a sound recovery was obtained in the patients; the average result of length of nail was （14.8 ±4.1 ） mm which was significantly longer than those of the other group; the average result of two point discrimination was （4.8±0.7） mm which was significantly lower than those of the other group; the average result of sensation measurement was S （3.55 ±0.45） which was significantly higher than those of the other group;the average

关 键 词：指损伤 静脉 静脉动脉化 修复外科手术 

分 类 号：R658.1[医药卫生—外科学]