邻指指掌侧固有动脉桥式转移重建多段离断指体远端血供  

Reconstruct the distal blood supply of multiple segments of severed finger body by arterial bridge transfer

作　　者：侯桥 庄伟 曾林如 洪生虎 任国华 陈城 瞿钢 全仁夫 HOU Qiao;ZHUANG Wei;ZENG Linru;HONG Shenghu;REN Guohua;CHEN Cheng;QU Gang;QUAN Renfu(Second Area of Hand Surgery Department,Jiangnan Hospital Affiliated to Binjiang College,Zhejiang University of Traditional Chinese Medicine,Hangzhou 311200,China)

机构地区：[1]浙江中医药大学滨江学院附属江南医院手外科2病区,杭州311200

出　　处：《中华显微外科杂志》2020年第3期243-247,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨应用邻指指掌侧固有动脉桥式转移重建多段离断指体远端血供的手术方法及治疗效果。方法自2005年11月至2019年2月,对7例7指3段离断的指体行再植术时,由于中段指体较短且挫伤严重,近端指掌侧固有动脉吻合后动力无法穿过中段为远段供血,为防止皮肤及血管分离太多导致中段内动脉与指体分离而影响成活,术中将中段动脉吻合后,用邻指指掌侧固有动脉桥式转移的方式与远段指体动脉做吻合提供供血,血管蒂部植皮4例,将皮肤缝合成皮管3例,并分别于术后3.5~6.0个月进行分指。分指时断蒂后动脉重新吻合者4例,直接邻指指掌侧固有动脉顺行转位者3例。术后定期采用门诊或电话随访,观察指体外观、感觉及手指关节总活动度,调查患者满意度,评定治疗效果。结果术后7例再植指体全部成活。随访时间5~40个月,7例手指得以保全,外观饱满,手指关节屈伸总活动度为100°~170°,手指腹TPD为7~12 mm,平均为9.6 mm。按照Michigan手部功能问卷评定标准,7例患者对手部整体外观及功能非常满意。按照中华医学会断指再植功能评定标准,3例效果为优,4例为良。结论采用邻指指掌侧固有动脉桥式转移的方式,可以跨节段为多段离断指体进行血供重建,是多段离断指体血供重建的一种简便、有效的方式。Objective To investigate the surgical method and therapeutic effect of reconstruction of distal blood supply of multiple segments of severed finger body by ortho phalanx artery bridge transfer.Methods Between November,2005 and February,2019,7 finger body was replanted in 7 cases with 3 segments.Due to the short middle finger body and severe bruising,the power could not pass through the middle section after the proximal finger artery anastomosis.For the long section of blood supply,in order to prevent the skin and blood vessels from separating too much and causing the middle internal artery to separate from the phalanx,after anastomosis of the middle artery,the blood supply was provided by anastomosis with the distal phalanx artery by means of the adjacent phalanx artery bridge.Four cases with vascular pedicle grafts.The skin was sewn into tube in 3 cases,and separate fingers between 3.5 and 6.0 months after operation.Four cases of posterior artery recalcitration and 3 cases of direct adjacent artery transposition.The appearance,sensation and total motion of finger joints were observed and the satisfaction of patients was investigated to evaluate the therapeutic effect.Results Seven patients with replantation finger were all alive after operation,and the follow-up time was 5 to 40 months respectively.The total range of motion of flexion and extension of finger joints was 100°-170°,and the TPD of finger pulp was 7-12 mm,with an average of 9.6 mm.According to Michigan's functional questionnaire,7 patients were satisfied with the overall appearance and function of their opponents.According to the evaluation standard of the replantation function of the broken finger of the Chinese Medical Association,3 cases were excellent and 4 cases were good.Conclusion It is a simple and effective way to reconstruct the blood supply of multi-segment severed fingers by means of adjacent finger artery bridge transfer.

关 键 词：指掌侧固有动脉 指体离断 断指再植 显微外科技术 

分 类 号：R658.2[医药卫生—外科学]