三种外增压技术改善指背筋膜蒂皮瓣修复效果的临床比较  

Clinical comparison of three kinds of supercharged techniques in the improvement of efficacy of digital fasciocutaneous flap

作　　者：郭礼平[1] 巨积辉[1] 王凯[1] 金光哲[1] 周荣[1] GUO Li-ping;JU Ji-hui;WANG Kai;JIN Guang-zhe;ZHOU Rong(Department of Hand Surgery,Ruihua Affiliated Hospital of Soochow University,Suzhou 215104,China)

机构地区：[1]苏州大学附属瑞华医院手外科,江苏苏州215104

出　　处：《中国美容整形外科杂志》2021年第11期682-685,703,共5页Chinese Journal of Aesthetic and Plastic Surgery

基　　金：江苏省青年医学人才项目(QNRC2016224)。

摘　　要：目的比较3种外增压技术用于指背筋膜蒂皮瓣转移修复指端缺损的临床效果。方法自2016年1月至2019年12月,苏州大学附属瑞华医院手外科对80例(80指)指端缺损患者采用指背筋膜蒂皮瓣进行移植修复,并将其随机分成A、B、C、D 4组,A组(20例)对皮瓣行动、静脉联合增压;B组(20例)行动脉外增压;C组(20例)行静脉外增压;D组(20例)不予以增压(无增压组)。术后1周,观察各组指背筋膜蒂皮瓣的并发症情况,以及6~8个月远期指体修复后的外形、功能、皮瓣感觉等情况。结果术后随访患者6~8个月,所有患者的皮瓣均成活。感染、肿胀的发生率4组之间比较,其差异无统计学意义(P>0.05)。皮瓣青紫、水疱的发生率:A组为5%(1例)、无;B组为无、5%(1例);C组为25%(5例)、65%(13例);D组为30%(6例)、60%(12例)。其中A、B组的发生率明显低于C组(P<0.05),而C组又明显低于D组(P<0.05)。术后6个月随访时,患者满意度、关节总活动度、静态两点辨别觉、寒冷耐受情况的评分以及供区愈后的优良率:A组分别为(51.21±9.02)%、(190.58±11.21)°、(9.21±2.80)mm、(60.22±7.98)分、95%;B组分别为(50.33±5.78)%、(185.22±13.05)°、(11.52±4.25)mm、(63.52±6.22)分、90%;C组分别为(48.32±3.58)%、(184.57±12.66)°、(13.92±2.98)mm、(67.12±3.53)分、75%;D组分别为(43.32±2.18)%、(164.52±10.10)°、(16.92±4.28)mm、(70.32±5.43)分、78%。上述的各个数值A、B、C组均优于D组(P<0.05);其中在患者满意度、关节总活动度及供区愈后优良率方面,A、B、C组比较其差异无统计学意义(P>0.05);在静态两点辨别觉、寒冷耐受情况方面,A组明显优于B、C组(P<0.05),而B组又优于C组(P<0.05)。结论 3种外增压技术用于指背筋膜蒂皮瓣移植修复指端缺损的疗效均优于传统的手术治疗方式,而动、静脉联合外增压较动脉外增压和静脉外增压的治疗方式获得了更好的皮瓣感觉及手指外形,是3种外增压技术Objective To compare and analyze the clinical efficacy of 3 kinds of supercharged technique in digital fasciocutaneous flap for the repair of fingertip defects. Methods From January 2016 to December 2019, 80 patients(80 fingers) with fingertip defects were repaired by digital fasciocutaneous flap. All patients were randomly divided into 4 groups, 20 patients in each group. Combined arterial and venous supercharged technique was performed in group A, arterial supercharged technique was performed in group B, venous supercharged technique was performed in group C and no supercharged technique was performed in group D. The complications of digital fasciocutaneous flap in each group at 1 week after operation were observed. The shape, function and sensation offinger at 6 to 8 months after repair were recorded. Results All patients were followed up for 6 to 8 months and all flaps survived. There was no significant difference in the incidence of concurrent infection and swelling among 4 groups(P>0.05). The incidence rate of skin flap cyanosis and blister: group A was 5%(1 case) and none;group B was none and 5%(1 case);group C was 25%(5 cases) and 65%(13 cases);group D was 30%(6 cases)and 60%(12 cases). The incidence of group A and B was significantly lower than that of group C(P<0.05), while group C was significantly lower than that of group D(P<0.05). At the follow-up of 6 months after operation, the patient satisfaction, total motion range of joint,static two-point discrimination, scores of cold tolerance and the excellent and good rate after donor site healing in group A was(51.21±9.02)%,(190.58±11.21)°,(9.21±2.80) mm,(60.22±7.98) points and 95%, respectively;group B was(50.33 ± 5.78)%,(185.22 ±13.05)°,(11.52±4.25) mm,(63.52±6.22) points and 90%, respectively;group C was(48.32 ± 3.58)%,(184.57±12.66)°,(13.92±2.98) mm,(67.12±3.53) points and 75%, respectively;group D was(43.32±2.18)%,(164.52±10.10)°,(16.92±4.28) mm,(70.32±5.43) points and 78%, respectively. The above values in group A, B and C were

关 键 词：指端缺损 指背筋膜蒂 外科皮瓣 动静脉联合外增压 动脉外增压 静脉外增压 疗效比较 

分 类 号：R658.2[医药卫生—外科学]