吻合浅静脉的指背神经筋膜蒂皮瓣修复Ⅲ型和Ⅳ型指端缺损的临床疗效  

Clinical efficacy of dorsal digital nerve fasciocutaneous pedicle flap with superficial vein anastomosis in repair of the typeⅢand type IV of fingertip defects

作　　者：郭亮 吴学军 林金贵 蓝贤峰 Guo Liang;Wu Xuejun;Lin Jingui;Lan Xianfeng(Department of Hand Surgery,Fuzhou Second Hospital Afiliaed to Xiamen University,Fuzhou 350000,China)

机构地区：[1]厦门大学附属福州第二医院手外科,福州350000

出　　处：《中华显微外科杂志》2019年第6期528-532,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨运用指背神经筋膜蒂皮瓣(DDNFPF)修复Ⅲ型和IV型指端缺损患者的临床疗效,以及吻合受区浅静脉对静脉危象发生率的影响。方法2017年2月-2018年12月,行DDNFPF修复指端缺损共85例92指,其中吻合浅静脉组30例32指,未吻合浅静脉组55例60指;运用卡方检验比较吻合和未吻合浅静脉组的术后优良率及静脉危象发生率,P<0.05为差异有统计学意义。术后定期随访。结果术后随访(7.0+2.9)个月,吻合静脉组术后静脉危象发生(1/32)较未吻合组(13/60)显著降低,差异有统计学意义(xr=4.217,P<0.05);两组术后优良率分别为96.8%和90.0%,差异无统计学意义(2=0.596,P>0.05)。两组修复后的指端外形良好,耐磨,持物稳定,两点辨别觉5~8 mm。结论DDNFPF修复II型和IV型指端缺损是一种安全有效的手术方式,吻合受区浅静脉可显著降低静脉危象发生率。Objective To analysis the elinical efficacy of dorsal digital nerves fasciocutaneous pedicle flap(DDNFPF)with superficial vein anastomosis in the treatment of the typeⅢand type IV of fingertip defect,and the relationship between the incidence of vein crisis and superficial vein anastomosis.Methods A total of 85 patients with 92 fingers,treated by DDNFPF from February,2017 to December,2018,were retrospectively analyzed.The superficial veins of 30 patients with 32 fingers were anastonosed,and 55 patients with 60 fingers were nol.The difference of the superior rate and the incidence of venous crisis between superficial vein anastomosis and non--superficial vein anastomosis was compared by Chi-square test.The difference was considered as statistically significant when P<0.05.The regular postoperative followed--up was performed.Results The average followed-up time was(7.0+2.9)months.The incidence of venous crisis in anastomosis group(1/32)was lower than that in non-anastomosis group(13/60).The dif-ference was statistically significant(x2=4.217,P<0.05).There was no signifcant difference in the superior rate between the 2 groups after operation(96.8%and 90.0%respectively,x2=0.596,P>0.05).The repaired fingertips of the 2 groups were in good appearance,wear-resistant,stable holders and two-point discrimination was 5 to 8 mm.Conclusion DDNFPF for the type II and IV type of fingetip defect is safe and effective.A anastomosis of superficial veins in recipient area can significantly reduce the incidence of venous crisis.

关 键 词：指背神经筋膜蒂皮瓣 指端损伤 吻合浅静脉 静脉危象 

分 类 号：R65[医药卫生—外科学]