腕掌侧游离动脉化静脉皮瓣与前臂静脉皮瓣修复术在手部创面修复中的应用  

Application of carpometacarpal free arterialized venous flap repair and forearm venous flap repair in repairing hand wounds

作　　者：向往 杨顺[1] 程亚博[1] 陈柯屹[1] 张静[1] Xiang Wang;Yang Shun;Cheng Yabo;Chen Keyi;Zhang Jing(Department of Wrist,Sichuan Provincial Orthopaedic Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院手腕科,成都610041

出　　处：《中国医学前沿杂志（电子版）》2021年第4期69-73,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：2019年四川省医学(青年创新)科研课题计划(S19049)。

摘　　要：目的探究腕掌侧游离动脉化静脉皮瓣与前臂静脉皮瓣在修复手部创面中的应用。方法选取2018年2月至2019年8月于四川省骨科医院接受治疗的86例手部创伤患者为研究对象。按照治疗方式不同将入选患者分为动脉化前臂静脉皮瓣组(接受腕掌侧游离动脉化静脉皮瓣修复术治疗)和前臂静脉皮瓣组(接受前臂静脉皮瓣修复术治疗),每组各43例。比较两组患者皮瓣成活率、术前和术后各时间点总主动活动度(total active movement,TAM)评分、皮肤恢复情况、创伤愈合情况和不良反应发生情况。结果动脉化前臂静脉皮瓣组患者创伤愈合时间显著短于前臂静脉皮瓣组(P<0.05),严重色素沉着发生率和术后不良反应发生率均显著低于前臂静脉皮瓣组(均P<0.05),皮瓣静态两点辨别觉显著小于前臂静脉皮瓣组(P<0.05),皮肤恢复正常比例和皮瓣成活率均显著高于前臂静脉皮瓣组(均P<0.05)。两组患者术后1周、1个月和2个月TAM评分较术前均逐渐升高(均P<0.05),动脉化前臂静脉皮瓣组患者术后各时间点TAM评分均显著高于同期前臂静脉皮瓣组(均P<0.05)。结论与前臂静脉皮瓣修复术相比,腕掌侧游离动脉化静脉皮瓣修复术用于手部创面修复可有效促进创面愈合,提高皮瓣成活率,加快术后恢复,降低不良反应发生率。Objective To explore the application of carpometacarpal free arterialized venous flap and forearm venous flap in repairing hand wounds.Method Eighty-six patients with hand wounds who were treated in Sichuan Provincial Orthopedics Hospital from February 2018 to August 2019 were selected as the research objects.They were divided into arterialized forearm venous flap group(treated with carpometacarpal free arterialized venous flap repair)and forearm venous flap group(treated with forearm venous flap repair)according to different treatment methods,with 43 cases in each group.The flap survival rate,total active movement(TAM)score at each time point before and after operation,skin recovery,wound healing and adverse reactions were compared between the two groups.Result The wound healing time in arterialized forearm venous flap group was shorter than that in forearm venous flap group(P<0.05),the incidence of severe pigmentation and postoperative adverse reactions were significantly lower than those in forearm venous flap group(all P<0.05),the static two-point discrimination of the flap was significantly smaller than that in forearm venous flap group(P<0.05),the proportion of skin returned to normal and flap survival rate were significantly higher than those in forearm venous flap group(all P<0.05).The TAM scores of the two groups increased gradually at 1 week,1 month and 2 months after operation compared with those before operation(all P<0.05),and the TAM scores of patients in arterialized forearm venous flap group were significantly higher than those in forearm venous flap group at the same period(all P<0.05).Conclusion Compared with the forearm venous flap repair,the carpometacarpal free arterialized venous flap repair for hand wounds can effectively promote wound healing,improve the flap survival rate,speed up postoperative recovery and reduce the incidence of adverse reactions.

关 键 词：手部创面 前臂静脉皮瓣 游离动脉化静脉皮瓣 修复 总主动活动度 

分 类 号：R658.2[医药卫生—外科学]