仅吻合单根指动脉指尖再植的疗效分析  

Analysis on the effect of fingertip replantation only anastomosed with a single digital artery

作　　者：田永宾[1] 王先威 马春英 王钦航 葛华平 TIAN Yongbin;WANG Xianwei;MA Chunying(Department of Third Surgery,The 983th Hospital of The Joint Logistics Support Force,Tianjin,300021,China)

机构地区：[1]中国人民解放军联勤保障部队第983医院外三科,天津300021 [2]天津市120急救中心,天津300000 [3]天津医科大学第二附属医院手足显微外科,天津300381

出　　处：《实用手外科杂志》2022年第2期142-144,共3页Journal of Practical Hand Surgery

摘　　要：目的 探讨仅吻合单根指动脉指尖再植的方法及疗效。方法 2014年3月-2018年10月,对19例离断指尖在显微镜下清创、探查,分别找到1根可供吻合的指动脉及2根指神经,骨折断端适当修剪并扩大髓腔后,用单根克氏针贯穿固定,显微镜下吻接指动脉及指神经,妥善修复甲床,并用无菌油纱覆盖,3/0丝线间断缝合皮肤;术后常规“三抗”治疗7~10 d,换药。结果 临床再植成活16例,坏死3例;临床成活病例中有3例出现甲床部分坏死,二期行末节指骨短缩缝合。术后随访6~24个月,平均12个月,13例成活指体饱满,指甲生长良好,两点辨别觉3~5 mm;3例指腹成活,出现不同程度的钩甲畸形。结论 仅吻合单根指动脉指尖再植通过妥善的围手术期处理,可获得较为满意的再植成功率。Objective To explore the method and effect of fingertip replantation only anastomosed with a single digital artery. Methods From March 2014 to October 2018, 19 severed fingertips were debrided and explored under the microscope. One finger artery and two finger nerves were found for anastomosis.After the broken end of the fracture was properly trimmed and expanded, the medullary cavity was penetrated and fixed with a single Kirschner wire. The finger artery and finger nerve were anastomosed under the microscope, and the nail bed was properly repaired and covered with sterile oil yarn, 3/0 silk thread intermittently sutured the skin;the patients were treated with three antibodies for 7~10 days after operation, and the blood scab around the wound edge was wiped in time during dressing change. Results Clinical replantation survived in 16 cases and necrosis in 3 cases, of which 3 cases had partial necrosis of nail bed and secondary suture of distal phalanx shortening. The patients were followed up for 6 ~24 months, with an average of 12 months, 13 cases survived with full fingers, good nail growth, static twopoint discrimination of 3~5 mm, and 3 cases survived with different degrees of uncinate nail deformity.Conclusion Fingertip replantation with only one digital artery anastomosis can obtain a satisfactory success rate through proper perioperative treatment.

关 键 词：指尖 再植 显微外科 

分 类 号：R658.1[医药卫生—外科学]