单侧中央动脉吻合在YamanoⅠ区手指离断伤再植中的应用  

Application of unilateral central artery anastomosis in replantation of amputated fingers in Yamano areaⅠ

作　　者：栾彦军[1] 白东昱 薛亮[1] LUAN Yan-jun;BAI Dong-yu;XUE Liang(Department of Joint Surgery,Affiliated Hospital of Yan'an University,Yan'an 716000,Shaanxi,CHINA)

机构地区：[1]延安大学附属医院关节外科,陕西延安716000

出　　处：《海南医学》2022年第20期2635-2638,共4页Hainan Medical Journal

摘　　要：目的观察单侧中央动脉吻合在YamanoⅠ区手指离断伤再植中的临床应用效果。方法选取2016年1月至2018年12月延安大学附属医院关节外科收治的115例YamanoⅠ区手指离断伤再植患者,按照手术方式不同分为对照组58例(采用指端创面放血法治疗)和观察组57例(术后不放血,仅吻合单侧中央动脉治疗),术后随访6~12个月(平均8.5个月),比较两组患者术后住院天数、换药次数、再植体愈合及成活情况、指甲生长长度、两点辨别觉、远端指间活动度和手指关节活动度优良率。结果观察组患者的住院天数为(14.86±1.52)d,少于对照组的(15.74±1.67)d,换药次数为(9.02±1.25)次/d,少于对照组的(9.68±1.34)次/d,差异均有统计学意义(P<0.05);术后第6个月,观察组患者再植体溃烂率和部分坏死率分别为1.8%、3.5%,明显低于对照组的12.1%、15.5%,再植体成活率为94.7%,明显高于对照组的82.8%,差异均有统计学意义(P<0.05);术后第6个月,观察组患者的指甲生长长度为(13.8±2.4)mm,明显长于对照组的(11.6±2.2)mm,远端指间活动度为(62.5±4.4)°,明显大于对照组的(46.7±3.8)°,两点辨别觉距离为(4.2±0.5)mm,明显短于对照组的(5.6±0.4)mm,差异均有统计学意义(P<0.05);术后第6个月,观察组患者的手指关节活动度优良率为93.0%,明显高于对照组的79.3%,差异具有统计学意义(χ2=4.487,P=0.034)。结论仅吻合单侧中央动脉再植YamanoⅠ区手指指尖能明显提高再植体的成活率,有效加快指甲生长速度和感觉神经恢复,同时改善关节活动度,临床效果满意。Objective To observe the application effect of unilateral central artery anastomosis in the replantation of amputated fingers in Yamano areaⅠ.Methods A total of 115 patients of amputated finger undergoing replantation in the Yamano areaⅠadmitted to the Department of Joint Surgery in Affiliated Hospital of Yan'an University were selected from January 2016 to December 2018.According to different surgical methods,they were divided into the the control group(n=58,phlebotomy therapy in fingertip wound)and observation group(n=57,unilateral central artery anastomosis,without phlebotomy).The patients were followed up for 6 to 12 months(8.5 months on average).The postoperative length of hospital stays,dressing change times,healing and survival of replantation,nail growth length,distance of two distinguishing points,distal interphalangeal range of motion,and excellent and good rate of finger joint range of motion were compared between the two groups.Results The postoerative length of hospital stays and dressing change times in the observation group were(14.86±1.52)d,(9.02±1.25)times/d,which were significantly lower than(15.74±1.67)d,(9.68±1.34)times/d in the control group(P<0.05).Six months after treatment,the replantation ulcer index and partial necrosis index in the observation group were 1.8%,3.5%,which were significantly lower than 12.1%,15.5%in the control group,and the survival rate of replantation was 94.7%,which was significantly higher than 82.8%in the control group(P<0.05).At 6 months after operation,the nail growth length of the observation group was(13.8±2.4)mm,which was significantly longer than(11.6±2.2)mm of the control group;the distal interphalangeal range of motion was(62.5±4.4)°,which was significantly greater than(46.7±3.8)°of the control group;the distance of two distinguishing points was(4.2±0.5)mm,which was significantly higher than(5.6±0.4)mm of the control group(P<0.05).At 6 months after operation,the excellent rate of finger joint range of motion of the observation group was 93.0%,

关 键 词：断指再植 血管吻合 成活率 临床疗效 中央动脉 两点辨别觉距离 

分 类 号：R622[医药卫生—整形外科]