指动脉转位在血管缺损性断指再植术中的应用及对神经和关节功能恢复的影响  

Application of digital artery transposition in replantation of fingers with vascular defects and its influence on nerve function and joint function recovery

作　　者：肖春来 鲍根强 张国辉 关玉龙 王泉 李华 Xiao Chunlai;Bao Genqiang;Zhang Guohui;Guan Yulong;Wang Quan;Li Hua(Department of Hand and Foot Surgery,Hengshui People's Hospital,Hengshui 053000,China)

机构地区：[1]衡水市人民医院手足外科,河北衡水053000

出　　处：《中华临床医师杂志（电子版）》2022年第3期220-225,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：河北省卫生健康委科研基金项目(20181573)。

摘　　要：目的探究指动脉转位在血管缺损性断指再植术中的应用及对神经功能、关节功能恢复的影响。方法选取2017年7月至2020年7月在衡水市人民医院接受断指再植的200例患者为研究对象,采用随机数字表法分为动脉转位组和静脉移植组,各100例。动脉转位组使用指动脉转位技术,静脉移植组使用自体静脉桥接移植技术。比较2组临床疗效、手术时间、断指成活率、血管危象发生率及断指再植后功能恢复情况、患者自觉满意度。结果动脉转位组临床优良率(91.00%vs 81.00%)、患者自觉满意度(96.00%vs 87.00%)均明显高于静脉移植组(P<0.05)。与静脉移植组相比,动脉转位组手术时间[(45.38±9.47)min vs(58.67±10.25)min]更短、断指成活率(95.00%vs 87.00%)更高(P<0.05)。2组血管危象发生率(19.00%vs 24.00%)差异无统计学意义(P>0.05)。动脉转位组指腹两点辨别觉较静脉移植组更短,感觉功能恢复情况也更好(P<0.05)。动脉转位组断指再植后掌指关节(MP)、近端指关节(PIP)、远端指关节(DIP)的活动度及日常生活活动评分均显著高于静脉移植组(P<0.05),但2组断指再植后恢复工作情况比较差异无统计学意义(P>0.05)。动脉转位组断指再植后血液循环状态和外观恢复情况均明显优于静脉移植组(P<0.05)。结论指动脉转位在血管缺损性断指再植术中的应用效果和安全性俱佳,不仅有效提高了断指成活率,还有利于患者术后神经功能、关节功能及外观的恢复。Objective To explore the application of digital artery transposition in replantation of fingers with vascular defects and its influence on nerve function and joint function recovery.Methods Two hundred patients who underwent replantation of severed fingers at Hengshui People's Hospital from July 2017 to July 2020 were selected and randomly divided into an arterial transposition group and a venous transplantation group according to the random number table method,with 100 cases in each group.The artery transposition group received finger artery transposition,while the vein graft group underwent autologous vein graft bridging.The clinical efficacy,operation time,survival rate of severed fingers,incidence of vascular crisis,functional recovery after replantation of severed fingers,and patient satisfaction were compared between the two groups.Results The clinically marked improvement rate(91.00%vs 81.00%)and patient satisfaction(96.00%vs 87.00%)in the arterial transposition group were significantly higher than those in the venous transplantation group(P<0.05).Compared with the venous transplantation group,the operation time in the arterial transposition group[(45.38±9.47)min vs(58.67±10.25)min]was shorter,and the survival rate of fingers(95.00%vs 87.00%)was higher(P<0.05).There was no significant difference in the incidence of vascular crisis between the two groups(19.00%vs 24.00%)(P>0.05).The arterial transposition group had shorter two-point discrimination and better sensory function recovery than the venous transplantation group(P<0.05).The activity scores of the metacarpophalangeal joint(MP),proximal interphalangeal joint(PIP),and distal interphalangeal joint(DIP),as well as the activities of daily living in the arterial transposition group were significantly better than those in the venous transplantation group(P<0.05);however,there was no significant difference in the recovery of fingers between the two groups(P>0.05).The blood circulation status and appearance recovery in the arterial transposition group were

关 键 词：指动脉转位 断指再植 血管缺损 神经功能 关节功能 

分 类 号：R658.1[医药卫生—外科学]