CAJ | 학술논문

目的：探讨指侧方静脉动脉化再植末节断指的疗效。方法2007年3月-2013年4月收治末节断指患者42例，均在正常指动脉多次吻合失败后行静脉动脉化再植。22例采用指侧方静脉动脉化再植，用近端指动脉与远端指侧方静脉吻合；22例采用指腹静脉动脉化再植，用近端指动脉与远端指腹静脉吻合。结果指侧方静脉动脉化组病例全部成活，创面均一期愈合；指腹静脉动脉化组4例坏死。27例获随访，随访时间6～15个月。指侧方静脉动脉化组18例，指外形佳，指腹饱满，指体无明显萎缩；手指各关节活动度参照TAM标准评定：优12例，良5例，可1例，优良率94.4%。指腹静脉动脉化组9例，指体轻度萎缩，指甲生长不平整；手指各关节活动参照TAM标准评定：优5例，良2，可2例，优良率77.8%。结论指侧方静脉动脉化有效克服了指腹静脉动脉化的解剖局限性，能提高再植指成活率，促进指甲生长及感觉恢复，增强DIPJ（distal interphalangeal joint, DIPJ）活动度，为正常供血多次失败后的末节断指提供了一种更有效的补救方法。
목적：탐토지측방정맥동맥화재식말절단지적료효。방법2007년3월-2013년4월수치말절단지환자42례，균재정상지동맥다차문합실패후행정맥동맥화재식。22례채용지측방정맥동맥화재식，용근단지동맥여원단지측방정맥문합；22례채용지복정맥동맥화재식，용근단지동맥여원단지복정맥문합。결과지측방정맥동맥화조병례전부성활，창면균일기유합；지복정맥동맥화조4례배사。27례획수방，수방시간6～15개월。지측방정맥동맥화조18례，지외형가，지복포만，지체무명현위축；수지각관절활동도삼조TAM표준평정：우12례，량5례，가1례，우량솔94.4%。지복정맥동맥화조9례，지체경도위축，지갑생장불평정；수지각관절활동삼조TAM표준평정：우5례，량2，가2례，우량솔77.8%。결론지측방정맥동맥화유효극복료지복정맥동맥화적해부국한성，능제고재식지성활솔，촉진지갑생장급감각회복，증강DIPJ（distal interphalangeal joint, DIPJ）활동도，위정상공혈다차실패후적말절단지제공료일충경유효적보구방법。
Objective To investigate the effect of veno-arteriolization of finger lateral vein for repairing severed finger tips. Methods From March 2007 to April 2013, 42 patients with severed finger tips were admitted to our center, with veno-arteriolization after failure in anastomosing artery of finger over times. 22 patients underwent veno-arteriolization of finger lateral vein. During operation, the digital artery proximal end and the finger lateral vein distal end was anastomosed as the route of blood supply. 20 patients underwent veno-arteriolization of finger pulp vein, the digital artery proximal end and the finger pulp vein distal end was anastomosed as the route of blood supply. Results All patients survived completely and achieved primary healing of wound after operation in veno-arteriolization of finger lateral vein group; 4 fingers necrosis in veno-arteriolization of finger pulp vein group. 27 patients were successfully followed up for 6 to 15 months. In veno-arteriolization of finger lateral vein group, 18 patients were successfully followed up, the fingers had satisfactory appearance, finger pulp was plump with good flexibility, no obvious deformed growth of nail were found, and a sound recovery was obtained in the patients; according to TAM scales, the results were excellent in 12 cases, good in 5 cases and fair in 1 cases, with an excellent and good rate of 94.4%. In veno-arteriolization of finger pulp vein group, 9 patients were successfully followed up, mild atrophy of the fingers;according to TAM scales, the results were excellent in 5 cases, good in 2 cases and fair in 2 cases, with an excellent and good rate of 77.8%. Conclusion The veno-arteriolization of finger lateral vein is a valuable method for repairing severed finger tips.