CAJ | 학술논문

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2；22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1；20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍；吻合指腹静脉组19例发生静脉危象,其中4例手指坏死；未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满；吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整；未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组[(14.4±3.2)mm比(12.5±2.3)mm和(12.2±2.2)mm],远侧指间关节活动度大于其他两组[(63±5)°比(48±3)°和(45±7)°],两点分辨觉小于其他两组[(4.6±0.4)mm比(7.1±1.2)mm和(7.3±0.6)mm],感觉级别高于其他两组[S(3.45±0.39)级比S(2.57±0.42)级和S(2.55±0.49)级],差异均具有显著性(P<0.05)。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义(P>0.05)。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。
목적：탐토불동방법중건지첨리단정맥회류적료효。방법：2008년3월-2013년2월수치지첨리단환자80례,38례문합지측방정맥중건회류,술중문합동정맥비례1：1혹1：2혹2：2,평균1：2；22례문합지복정맥중건회류,술중문합동정맥비례1：1；20례미문합정맥,술중부문합1조동맥,행측절구혹갑상방혈。관찰각조치료효과。결과：문합지측방정맥조수지전부성활,무일례발생회류장애；문합지복정맥조19례발생정맥위상,기중4례수지배사；미문합정맥조20례균발생회류장애,기중6례수지배사。58례획수방,수방시간6~28개월。문합지측방정맥조32례,지첨외형가、지복포만；문합지복정맥조14례,지체경도위축,지갑생장불평정；미문합정맥조12례,지체위축명현。문합지측방정맥조지갑생장근평정,장도장우기타량조[(14.4±3.2)mm비(12.5±2.3)mm화(12.2±2.2)mm],원측지간관절활동도대우기타량조[(63±5)°비(48±3)°화(45±7)°],량점분변각소우기타량조[(4.6±0.4)mm비(7.1±1.2)mm화(7.3±0.6)mm],감각급별고우기타량조[S(3.45±0.39)급비S(2.57±0.42)급화S(2.55±0.49)급],차이균구유현저성(P<0.05)。문합지복정맥조화미문합정맥조재지갑장도、운동화감각방면차이무통계학의의(P>0.05)。결론：문합지측방정맥능유효해결지첨재식정맥회류문제,가피면회류장애,성활솔고,촉진지갑생장,가회복 DIPJ 활동도급감각。
Objective:To investigate the effect of different methods on reconstruction of venous return of severed fingertip. Methods:From March 2008 to February 2013,80 patients with severed fingertip were admitted to the Department of Hand Sur-gery. Among the 80 patients,38 patients underwent anastomosis of lateral veins of the finger,the ratio of artery:vein was 1:1,1:2 or 2:2,with mean proportion of 1:2;22 patients underwent anastomosis of finger pulp veins,the anastomotic ratio of artery:vein was 1:1;20 patients underwent anastomosis of one artery without anastomosis of veins,followed by bleeding from the nail bed or lateral-incision of finger. Results:All fingertips survived completely without venous obstruction in lateral veins an-astomosis group;1 9 fingers showed return obstruction,and necrosis occurred in 4 fingers in anastomosis of finger pulp veins group;return obstruction occurred in 20 fingers and necrosis occurred in 6 fingers in the group without vein anastomosis. Fifty-eight patients were followed up for 6 to 28 months. In 32 patients the appearance was satisfactory,finger pulp was plump,with-out deformity of nail in the group with anastomosis of lateral veins. Fourteen patients in finger pulp veins anastomosis group showed mild atrophy of the fingers;significant atrophy of the fingers was found in 12 patients in non-anastomosis group. The mean length of nail,mobility of distal interphalangeal j oint,two point discrimination,and sensation were better in lateral veins anastomosis group [(14.4±3.2)mm,(63±5)°,(4.6±0.4)mm,S(3.45±0.39)]. The result was significantly better than those in finger pulp veins anastomosis group [(12.5±2.3)mm,(48±3)°,(7.1±1.2)mm,S(2.57±0.42)],and in the group without vein anastomosis [(12.2±2.2)mm,(45±7)°,(7.3±0.6)mm,S(2.55±0.49);P<0.05]. There was no significant difference in length of nail,mobility of distal interphalangeal j oints,two point discrimination,and sensory measurement between the latter two groups(P>0.05).Conclusions:The anastomosis of lateral veins of the finger is a valuable method for replantation of severed fingertip,and it can avoid obstruction of venous circulation,increase survival rate of severed finger,promote growth of nail,and restore motion and sensation of fingers.