摘要
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。
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.
出处
《首都医科大学学报》
CAS
2014年第3期353-357,共5页
Journal of Capital Medical University
基金
江苏省科技计划重点资助项目(BS2007054)
南京军区科技创新重点资助项目(07Z028)~~
关键词
静脉动脉化
修复外科手术
断指再植
veno-arterialization
reconstructive surgical procedures
replantation of severed finger
