摘要
目的探讨2针法吻合弓上动脉再植微小指尖离断的临床疗效及可行性。方法回顾性病例系列研究。纳入2021年5月—2024年5月南京江北医院手足显微外科30例(30指)微小指尖离断进行再植的患者,其中男19例、女11例,年龄15~62(38.5±1.6)岁。患者微小指尖动脉断裂平面均位于动脉弓以远的弓上动脉处,弓上动脉断裂平面口径0.1~0.3 mm。离断指尖再植术中,均采用2针法吻合,即于血管壁12(9)点位、6(3)点位各缝合1针,端端吻合弓上动脉。术后采用门诊、微信、电话相结合方式进行定期随访,随访内容包括再植指体外形、功能、感觉恢复情况。按中华医学会手外科学会对断指再植术后功能评定标准评估再植手指功能。结果本组30例30指再植微小指尖全部成活,无一例发生血管危象。术后均获随访,随访时间为6~30个月,平均7个月。末次随访:30例30指再植指体外形佳,功能恢复良好,远指间关节的活动度为36°~42°、平均38°,指腹感觉S3~S4、平均S3+,微小指尖两点分辨觉为5~7 mm、平均6 mm,与健指几乎一样;再植指功能优26指、良4指,优良率100%。结论2针法吻合弓上动脉技术用于再植微小指尖离断,再植指成活率高,无血管危象,是微小指尖离断再植行之有效的方法。
Objective This study aimed to investigate the clinical curative effect and feasibility of ting fingertip replantation with end-to-end anastomosis of superior digital arch artery using two needle sutures.Methods A case series study was conducted by retrospectively analyzing the data of 30 patients(30 digits)with completely severed ting fingertips admitted to the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital from May 2021 to May 2024.The patients were composed of 19 males and 11 females aged 15-62(38.5±1.6)years.All arterial dissections were distal to the digital arterial arch,with the vessel caliber ranging from 0.1 mm to 0.3 mm.During the end-to-end anastomosis of superior digital arch artery,one needle suture was performed at 12(9)points of the vascular wall,and another at 6(3)points of the vascular wall.All the patients were scheduled for follow-ups through a combination of outpatient clinical visits and WeChat or telephone reviews.Postoperative follow-up included fingertip shape,flexion and extension function,and sensation recovery.Clinical efficacy was examined in accordance with the standard functional evaluation issued by the Hand Surgery Association of Chinese Medical Association.Results All 30 ting fingertips survived completely,with no vascular crisis occurring after the operation.All 30 patients were followed up for 6-30 months with an average of 7 months.At the final follow-up,the shape of the ting fingertip was good,the appearance was close to that of the healthy finger,and the active range of motion of the distal interphalangeal joint was 36°-42°with an average of 38°.The sensation recovery of the finger pulp was scored S3-S4 with an average of S3+,and the two-point discrimination of the ting fingertip was 5-7 mm with an average of 6 mm.No difference from the healthy finger was observed.According to the standard functional evaluation issued by the Hand Surgery Association of Chinese Medical Association,26 of the cases were excellent and 4 were good.The excellent and good rate was 100%.Conclusion Ting fingertip replantation with end-to-end anastomosis of superior digital arch artery using two needle sutures is an treatment method with the high survival rate of replanted fingers and no vascular crisis.
作者
何兵
江起庭
姚翔
邱福平
张磊
王斌
He Bing;Jiang Qiting;Yao Xiang;Qiu Fuping;Zhang Lei;Wang Bin(Department of Hand and Foot Microsuegery,Nanjing Jiangbei Hospital,Nanjin 210048,China)
出处
《中华解剖与临床杂志》
2025年第9期608-613,共6页
Chinese Journal of Anatomy and Clinics
基金
南京市医学重点科技发展项目(ZKX24062)。
关键词
指损伤
断指再植
弓上动脉吻合
指尖离断
缝合技术
Finger injuries
Replantation of amputated finger
Anastomosis of superior digital arch artery
Severed fingertip
Suture techniques
