首都医科大学学报
首都醫科大學學報
수도의과대학학보
JOURNAL OF CAPITAL UNIVERSITY OF MEDICAL SCIENCES
2014年
3期
353-357
,共5页
静脉动脉化%修复外科手术%断指再植
靜脈動脈化%脩複外科手術%斷指再植
정맥동맥화%수복외과수술%단지재식
veno-arterialization%reconstructive surgical procedures%replantation of severed finger
目的：通过与传统指腹静脉动脉化再植比较,探讨指侧方静脉动脉化再植末节断指的可行性及疗效。方法将2006年3月至2012年4月收治并符合选择标准的34例(34指)末节断指患者纳入研究,均为正常指动脉多次吻合失败后行静脉动脉化。将患者采用数字表法随机分为2组,20例采用指侧方静脉动脉化再植(试验组),用近端指动脉与远端指侧方静脉吻合；14例采用指腹静脉动脉化再植(对照组),用近端指动脉与远端指腹静脉吻合。两组患者性别、年龄、致伤原因、病程、损伤指别、末节分型、动脉吻合失败次数及骨折、神经损伤比较,差异均无统计学意义(P>0.05),具有可比性。结果术后试验组再植指均成活,成活率100%(20/20)；对照组4例再植指坏死,成活率为71.4%(10/14)；两组再植指成活率比较,差异有统计学意义(P =0.022)。27例获随访,其中试验组18例,随访时间6~14个月,平均10.2个月；对照组9例,随访时间8~12个月,平均9.6个月。试验组再植指均外形佳,指甲生长近平整；对照组再植指均出现轻度萎缩,指甲生长均不平整。术后6个月试验组再植指指甲长度、远端指间关节(distal interphalangeal joint,DIPJ)活动度及手指感觉、两点辨别觉均优于对照组,差异有统计学意义(P<0.05)。手指各关节活动度参照总主动活动度评价标准：试验组获优12例,良5例,可1例,优良率94.4%；对照组获优5例,良2例,可2例,优良率77.8%；两组优良率比较差异无统计学意义(P =0.250)。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 活动度,为正常供血多次失败后的末节断指提供了一种有效的补救方法。
目的：通過與傳統指腹靜脈動脈化再植比較,探討指側方靜脈動脈化再植末節斷指的可行性及療效。方法將2006年3月至2012年4月收治併符閤選擇標準的34例(34指)末節斷指患者納入研究,均為正常指動脈多次吻閤失敗後行靜脈動脈化。將患者採用數字錶法隨機分為2組,20例採用指側方靜脈動脈化再植(試驗組),用近耑指動脈與遠耑指側方靜脈吻閤；14例採用指腹靜脈動脈化再植(對照組),用近耑指動脈與遠耑指腹靜脈吻閤。兩組患者性彆、年齡、緻傷原因、病程、損傷指彆、末節分型、動脈吻閤失敗次數及骨摺、神經損傷比較,差異均無統計學意義(P>0.05),具有可比性。結果術後試驗組再植指均成活,成活率100%(20/20)；對照組4例再植指壞死,成活率為71.4%(10/14)；兩組再植指成活率比較,差異有統計學意義(P =0.022)。27例穫隨訪,其中試驗組18例,隨訪時間6~14箇月,平均10.2箇月；對照組9例,隨訪時間8~12箇月,平均9.6箇月。試驗組再植指均外形佳,指甲生長近平整；對照組再植指均齣現輕度萎縮,指甲生長均不平整。術後6箇月試驗組再植指指甲長度、遠耑指間關節(distal interphalangeal joint,DIPJ)活動度及手指感覺、兩點辨彆覺均優于對照組,差異有統計學意義(P<0.05)。手指各關節活動度參照總主動活動度評價標準：試驗組穫優12例,良5例,可1例,優良率94.4%；對照組穫優5例,良2例,可2例,優良率77.8%；兩組優良率比較差異無統計學意義(P =0.250)。結論指側方靜脈動脈化有效剋服瞭指腹靜脈動脈化的解剖跼限性,能提高再植指成活率,促進指甲生長及感覺恢複,增彊 DIPJ 活動度,為正常供血多次失敗後的末節斷指提供瞭一種有效的補救方法。
목적：통과여전통지복정맥동맥화재식비교,탐토지측방정맥동맥화재식말절단지적가행성급료효。방법장2006년3월지2012년4월수치병부합선택표준적34례(34지)말절단지환자납입연구,균위정상지동맥다차문합실패후행정맥동맥화。장환자채용수자표법수궤분위2조,20례채용지측방정맥동맥화재식(시험조),용근단지동맥여원단지측방정맥문합；14례채용지복정맥동맥화재식(대조조),용근단지동맥여원단지복정맥문합。량조환자성별、년령、치상원인、병정、손상지별、말절분형、동맥문합실패차수급골절、신경손상비교,차이균무통계학의의(P>0.05),구유가비성。결과술후시험조재식지균성활,성활솔100%(20/20)；대조조4례재식지배사,성활솔위71.4%(10/14)；량조재식지성활솔비교,차이유통계학의의(P =0.022)。27례획수방,기중시험조18례,수방시간6~14개월,평균10.2개월；대조조9례,수방시간8~12개월,평균9.6개월。시험조재식지균외형가,지갑생장근평정；대조조재식지균출현경도위축,지갑생장균불평정。술후6개월시험조재식지지갑장도、원단지간관절(distal interphalangeal joint,DIPJ)활동도급수지감각、량점변별각균우우대조조,차이유통계학의의(P<0.05)。수지각관절활동도삼조총주동활동도평개표준：시험조획우12례,량5례,가1례,우량솔94.4%；대조조획우5례,량2례,가2례,우량솔77.8%；량조우량솔비교차이무통계학의의(P =0.250)。결론지측방정맥동맥화유효극복료지복정맥동맥화적해부국한성,능제고재식지성활솔,촉진지갑생장급감각회복,증강 DIPJ 활동도,위정상공혈다차실패후적말절단지제공료일충유효적보구방법。
Objective To explore the effectiveness of veno-arterialization of finger lateral vein for repairing severed finger tips by comparing with veno-arterialization of finger pulp vein. Methods From March 2006 to April 2012, thirty-four patients with severed finger tips were admitted to our center, with veno-arterialization after failure in anastomosing artery of finger over times. Twenty patients underwent veno-arterialization of finger lateral vein(20 fingers, trial group). During operation, the digital artery proximal end and the finger lateral vein distal end was anastomosed as the route of blood supply. Fourteen patients underwent veno-arterialization of finger pulp vein(14 fingers, control group), the digital artery proximal end and the finger pulp vein distal end were anastomosed as the route of blood supply. There was no significant difference in gender, age, cause of injury, duration of disease, finger of injury, lesion segments, failure in anastomosing artery of finger over times, fracture, and nerve damage between 2 groups(P>0. 05). Results All patients survived completely in trial group, the survival rate was 100% (20 / 20); Four fingers necrosis in control group, the survival rates was 71. 4% (10 /14); there were significant difference in results between 2 groups(P = 0. 022). Twenty seven patients were successfully followed up, eighteen patients were successfully followed up 6-14 months(mean, 10. 2 months) in trial group, 9 patients were successfully followed up 8-12 months(mean, 9. 6 months) in control group. 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 trial group; mild atrophy of the fingers in control group. The postoperative length of nail, motion of distal interphalangeal joint ( DIPJ ), sensation measurement, and two point discrimination were improved significantly when compared with preoperative values in 2 groups(P<0. 05). 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 trial group, 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% in control group, there were no significantly improved(P=0. 250). Conclusion The veno-arterialization of finger lateral vein is a valuable method for repairing severed finger tips, which can promote growth of nail, and restore motion and sensation of fingers.
