动静脉吻合联合撕脱皮肤回植在手指皮肤逆行撕脱伤中的应用  

Application of arteriovenous anastomosis combined with avulsion skin replantationin the patients with the retrograde avulsion injury of finger skin

作　　者：邢耀文 王占平 苏锴 XING Yaowen;WANG Zhanping;SU Kai(Department of Hand&Foot Trauma and Microsurgery,Shangqiu Municipal Hospital,Shangqiu 476000,China)

机构地区：[1]商丘市立医院手足创伤显微外科,商丘476000

出　　处：《华夏医学》2024年第6期124-129,共6页Acta Medicinae Sinica

基　　金：河南省医学科技攻关计划联合共建项目(2018020706)。

摘　　要：目的探究显微镜下动静脉吻合联合撕脱皮肤回植在手指皮肤逆行撕脱伤中的应用效果。方法选取我院手指皮肤逆行撕脱伤患者78例,采取非随机对照试验设计,根据治疗方式的不同以及患者自愿原则分为吻合组和对照组,经样本量估算两组各纳入41例(43指)、37例(38指)患者,对照组行原位皮肤回植联合负压封闭引流,吻合组行显微镜下动静脉吻合联合撕脱皮肤回植。比较两组患者治疗情况、手指关节活动优良率、恢复工作情况、日常生活能力、并发症发生情况。结果吻合组回植成活率97.67%高于对照组84.21%,差异有统计学意义(P<0.05)。吻合组患者手指关节活动优良率92.68%高于对照组78.38%(P<0.05)。治疗后3个月,吻合组患者恢复工作情况优于对照组(P<0.05),日常生活活动量表得分高于对照组(P<0.05)。吻合组的并发症总发生率低于对照组(P<0.05)。结论显微镜下动静脉吻合联合撕脱皮肤回植治疗手指皮肤逆行撕脱伤效果显著,能够改善患者手指关节活动度,提高患者日常生活能力,安全性更高。Objective To explore the application effect of microscopic arteriovenous anastomosis combined with avulsed skin replantation in the patients with retrograde avulsion injury of finger skin.Methods 78 patients with retrograde avulsion injuries of finger skin were divided into the anastomosis group and the control group.The patients in the control group were underwent in situ skin replantation combined with negative pressure.The patients in the anastomosis group were underwent arteriovenous anastomosis combined with avulsed skin replantation under a microscope.The treatment conditions,excellent and good rate of finger joint activities,return to work,daily living ability,and occurrence of complications were compared between the two groups of patients.Results The survival rate of reimplantation in the anastomosis group was 97. 67% higher than 84. 21% in the control group, showing astatistically significant difference (P<0.05). The percentage of patients was 92.68% in the anastomosis group higherthan 78.38% in the control group(P < 0. 05). Three months after treatment, patients returned to work in theanastomosis group better than that in the control group(P<0.05), and the activities of daily life scale scored higherthan that in the control group(P<0.05). The overall incidence of complications in the anastomosis group was lowerthan that in the control group(P<0.05). Conclusion Microscopic arteriovenous anastomosis combined with avulsionskin replantation has a good therapeutic effect in the patients with retrograde avulsion injury of finger skin. Itimproves the patient′s finger joint mobility and improves the patient′s daily living ability, and is safe.

关 键 词：手指 撕脱伤 显微镜 动静脉吻合 负压封闭引流 皮肤回植 

分 类 号：R686.3[医药卫生—骨科学]