利用中央动脉分支静脉化重建TamaiⅠ区断指回流的临床应用  

Clinical application of using single central artery bifurcation technique for Tamai＆#39;s zone Ⅰ distal replantation

作　　者：冯仕明[1] 王爱国[1] 程建[1] 张在轶 孙擎擎[1] 周明明[1] 郝云甲[1] 

机构地区：[1]江苏省徐州市中心医院手足显微外科,221009

出　　处：《中华解剖与临床杂志》2017年第6期486-490,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的 探讨利用中央动脉分支静脉化重建TamaiⅠ区断指回流的疗效.方法 回顾性分析2013年9月—2015年2月徐州市中心医院手足显微外科收治的27例27指TamaiⅠ区完全离断断指患者的临床资料.其中男16例、女11例,年龄18~51岁;拇指3例,示指9例,中指7例,环指5例,小指3例.患者均采用中央动脉分支静脉化治疗,术后观察患指外观、指甲生长及手指感觉情况,采用Tamai评分对手术治疗效果进行评价.结果 所有患指顺利成活,无一例出现动脉血供不足或静脉回流障碍危象,伤口均获得一期愈合,未出现再植指体的部分坏死.25例患者获得随访,随访时间6~20（13.3＆#177;3.5）个月.末次随访时,指体外观恢复满意,指甲生长平整,未见明显萎缩,指腹两点辨别觉为4.5~6.5（5.4＆#177;0.7）mm.按照Tamai评分标准评定疗效：优24例,良1例,优良率为100%.结论 采用中央动脉分支静脉化重建TamaiⅠ区断指回流,具有安全可靠、成活率高、指甲正常生长等优点,是末节无可供吻合的静脉及可供静脉化的第二条动脉型断指的一种新的、有效的治疗方法.Objective To introduce the clinical application of using the single central artery bifurcation technique for Tamai ＆#39;s zone Ⅰ distal replantation.Methods From September 2013 to February 2015, 27 patients （27 fingers） of Tamai＆#39;s zone Ⅰ distal amputation were retrospectively followed in Xuzhou Central Hospital.There were 16 males and 11 females, aged 18 -51 years.Among them, the thumb was involved in 3 cases, the index finger in 9 cases, the middle finger in 7 cases, the ring finger in 5 cases, and the little finger in 3 cases.The single central artery bifurcation technique was used for treatment .Main outcome measures included the finger appearance , nails smoothness and finger sensation .Patients were scored using the Tamai＆#39;s scale.Results All fingers were replanted successfully without evidence of arterial insufficiency or venous congestion .The wound healed by first intention, and partial necrosis was not identified postoperatively in any fingers .Twenty-five patients were successfully followed up for 6 to 20 months （average, 13.3 ＆#177;3.5 months） .At the final follow-up, the fingers appearances were satisfactory , nails were neady smooth, and no obvious atrophy of finger was found .The finger-pulp mean values of static 2-point discrimination were 5.4 ＆#177;0.7 mm （range, 4.5 -6.5 mm） .In our series, based on the Tamai＆#39;s classification, the results were excellent in 24 cases, good in 1 case, with anthe excellent and or good rate of was 100%.Conclusions The single central artery bifurcation technique can be used safely , with high survival rate which is an ideal choice to promote growth of nail when there was no volar vein , dorsal vein, or second artery available in the amputated part for standard venous drainage .

关 键 词：指损伤 再植术 指中央动脉 动静脉吻合 显微外科手术 

分 类 号：R658.1[医药卫生—外科学]