三种指动脉吻合法在小儿UrbaniakⅢ型拇手指套脱性离断再植中的应用  

Clinical application of three kinds of anastomosis methods of digital artery in replantation of degloving amputated thumb and fingers of UrbaniakⅢtype in children

作　　者：王凯[1] 巨积辉[1] 金光哲[1] 郭礼平[1] 郭全伟[1] Wang Kai;JuJihui;Jin Guangzhe;Guo Liping;Guo Quanwei(Department of Pediatric Orthopedics,Ruihua Hospital Affiliated to Suzhou University,Suzhou 215104,China)

机构地区：[1]苏州大学附属瑞华医院小儿骨科,苏州215104

出　　处：《中华手外科杂志》2019年第6期415-418,共4页Chinese Journal of Hand Surgery

基　　金：江苏省青年医学人才项目(QNRC2016221)。

摘　　要：目的报告三种指动脉吻合法在小儿拇手指套脱性离断再植中的应用和临床疗效。方法自2012年5月至2018年7月,我们对16例17指手指套脱性离断伤患儿进行再植术。根据手指皮肤撕脱平面不同,按侯瑞兴手指套脱伤Ⅲ型分度方法,Ⅰ度6指、Ⅱ度11指。三种指动脉吻合方式为原位吻合双侧指动脉7例8指、交叉吻合一条指动脉7例7指、转位邻指指动脉吻合2例2指。结果本组16例17指顺利完成再植.术后通血良好,其中吻合双侧指动脉7例8指均存活,交叉吻合一条指动脉3例3指发生坏死,转位吻合指动脉2例2指均存活。13例14指存活患者均获得随访,时间为3~36个月,平均18个月。吻合双侧指动脉患指均有指甲生长,其中2例指甲生长畸形,1例末节指骨部分吸收导致末节指体短小,而捏握功能正常.皮肤色泽、温度正常;交叉吻合一条指动脉存活4例患指均有指甲生长,其中2例指甲生长畸形,2例末节指骨部分吸收导致末节指体明显短小,不影响持物功能,皮肤色泽稍差、温度略低,指体稍萎缩;转位吻合指动脉患指均有指甲生长,其中1例指甲生长畸形,指体较健侧短而粗,屈伸活动可.皮肤色泽正常、皮温稍低。按中华医学会手外科学会断指再植功能评定试用标准评定:优7例,良4例,差2例。结论对于小儿UrbaniakⅢ型手指套脱性离断伤,只要指体较完整均应行再植术.尽量采用原位吻合双侧指动脉重建血供,该方法再植术后成活率高.指体外形功能恢复较好。Objective To report the clinical application and efficacy of three kinds of anastomosis methods of digital artery in replantation of degloving amputated thumb and fingers in children.Methods From May 2012 to July 2018,16 children with 17 fingers of degloving amputated injuries were replanted.According to Hou Ruixing's classification method of finger degloving injury type HI,the cases were classified intoⅠdegree of 6 fingers,Ⅱdegree of 11 fingers base on different skin avulsion planes.Three kinds of anastomosis methods of digital artery were in situ anastomosis of bilateral digital artery in 7 cases 8 fingers,cross anastomosis of a digital artery in 7 cases 7 fingers and transposition anastomosis of adjacent digital artery in 2 cases 2 fingers.Results The replantation of 17 fingers in 16 cases was successfully completed.The postoperative blood circulation was good.Among them,7 cases 8 fingers with bilateral digital artery anastomosis survived,3 cases 3 fingers with cross anastomosis of a digital artery occurred necrosis,and 2 cases 2 fingers with transposition anastomosis of digital artery survived.Thirteen patients with 14 fingers survived were follow-up for 3 to 36 months,with an average of 18 months.The growth of nails was found in all the fingers anastomosed with bilateral phalangeal arteries,including 2 cases of nail growth deformity,1 case of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body,while the function of pinching and the skin color and temperature were normal.The growth of nails was found in 4 surviving affected fingers with cross anastomosis of a digital artery,including 2 cases of nail growth deformity,2 cases of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body,which did not affect the holding function with slightly poor skin color,low temperature and finger body atrophy.The growth of nails was found in all the fingers with transposition anastomosis of digital artery,including 1 case

关 键 词：再植术 治疗效果 儿童 套脱伤 

分 类 号：R65[医药卫生—外科学]