吻合指侧方静脉重建指尖再植回流的临床研究

目的 探讨吻合指侧方静脉重建指尖再植回流的临床疗效.方法 回顾性分析2008年3月至2012年12月,采用吻合指侧方静脉重建回流术治疗36例指尖离断患者资料,男21例,女15例；年龄15～52岁,平均(29.5±6.6)岁；拇指3例,示指9例,中指9例,环指7例,小指8例.致伤原因:挤压伤12例,电锯伤8例,切割伤16例.指尖分型:Ⅰ型14例,Ⅱ型5例,Ⅲ型10例,Ⅴ型7例.术中吻合动、静脉比例1∶1、1∶2或2∶2,平均1∶2.结果 36例指尖全部成活,无一例发生回流障碍,其中3例于术后出现动脉危象,经药物和手术治疗后成活.30例获随访,随访时间6～24个月,平均(12.4±2.8)个月.指尖外形佳、指腹饱满,指体无明显萎缩；指甲生长近平整,长度10.5～18.9 mm,平均(14.4±3.2) mm；远侧指间关节活动度为0°～70°,平均63°±5°；两点分辨觉为4.2～6.0 mm,平均(4.6±0.4) mm；感觉测定为S3～S4级.Tamai评分68～100分,其中优28例,良2例,优良率为100％.结论 吻合指侧方静脉能有效解决指尖再植回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复远侧指间关节活动度及感觉.

Clinical research on finger lateral veins anastomosis for restoring venous return of severed fingertip

Objective To investigate effect of finger lateral veins anastomosis for restoring venous return of severed fingertip. Methods From March 2008 to December 2012, 36 patients underwent finger lateral veins anastomosis, including 21 males and 15 females, aged from 15 to 52 years (average, 29.5±6.6 years). The thumb was involved in 3 cases, the index finger in 9 cases, the middle finger in 9 cases, the ring finger in 7 cases, and the little finger in 8 cases. The causes of injury included crush injury in 12 cases, electric saw injury in 8 cases, and incised injury in 16 cases. According to type of fingertip injury, there were 14 cases of type I, 5 cases of type II, 10 cases of type III, and 7 cases of type V. The ratios of anastomotic artery and veins were 1∶1, 1∶2 or 2∶2 (average, 1∶2). Results Thirty-six fingertips survived completely and no venous return obstruction happened, arterial crisis occurred in 3 cases after operation, which were cured after operative and medication treatment. Thirty patients were successfully followed up for 6 to 24 months (average, 12.4±2.8 months). The fingers' appearances were satisfactory, finger pulps were plump with good flexibility, and no obvious atrophy of finger was found. The nails were nearly smooth, and the length of nails ranged from 10.5 to 18.9 mm (average, 14.4±3.2 mm). The motion of distal interphalangeal joints, the two point discrimination, and the results of sensation measurement ranged from 0° to 70° (average, 63°±5°), 4.2 to 6.0 mm (average, 4.6±0.4 mm), and S3 to S4, respectively. According to Tamai's classification, Tamai score increased from 68 to 100 at final follow-up, the results were excellent in 28 cases, good in 2 cases, with an excellent and good rate of 100%. Conclusion The finger lateral veins anastomosis is an effective method for restoring venous return of severed fingertip, which can avoid venous return obstruction, promote growth of nail, and restore motion and sensation of fingers.