两种静脉动脉化在末节断指再植中应用的疗效观察
收稿日期: 2014-01-14
网络出版日期: 2014-12-04
基金资助
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）
Analysis of curative effect of two methods of veno-arteriolization for repairing severed finger tips
Received date: 2014-01-14
Online published: 2014-12-04
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于末节断指再植中应用的可行性及疗效。 方法 回顾性分析2006年3月至2012年4月间行指侧方静脉动脉化再植断指20例患者的临床资料（试验组），并于同期采用指腹静脉动脉化再植14例的临床结果（对照组）进行比较。 结果 试验组与对照组比较，其成活率明显提高（100%vs. 71.4%）；指甲长度增加（15.6±2.7 mm vs 11.9±2.2 mm）；DIPJ活动度增加 （62±4°vs 45±3°）；指感觉测定增加（S3+ vs S3）；两点辨别觉减小（4.6±0.3mm vs 7.4±0.6 mm）；指关节活动优良率增加（94.4% vs 77.8%）；组间比较差异有统计学意义（P<0.05）。 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。
江起庭 , 杨丽娜 , 王钰 , 江志伟 . 两种静脉动脉化在末节断指再植中应用的疗效观察[J]. 中国临床解剖学杂志, 2014 , 32(6) : 725 -728 . DOI: 10.13418/j.issn.1001-165x.201
Objective To explore the effectiveness of veno-arteriolization of finger lateral vein for repairing severed finger tips by comparing with veno-arteriolization of finger pulp vein. Methods From March 2006 to April 2012, 20 patients underwent veno-arteriolization of finger lateral vein (20 fingers, trial group). 14 patients underwent veno-arteriolization of the finger pulp vein (14 fingers, control group), Clinical data and surgical outcomes were compared retrospectively. Results All patients survived completely in trial group. The survival rate in the trial group was higher than in the control group (100% vs 71.4%); the postoperative length of nail was greater in the trial group (15.6±2.7 mm vs 11.9±2.2 mm); the motion of DIP joint was greater in trial group (62°±4° vs 45°±3°). The sensation restoration in the trial group was greater in trial group (S3+ vs S3); the excellent and good rate of interphalangeal activity was greater in the trial group (94.4% vs 77.8%）. There was statistical significance between the two groups (P<0.05). Conclusion The veno-arteriolization of finger lateral vein is a valuable method for repairing severed finger tips, which can promote growth of the nail, and restore motion and sensation of fingers.
[1] Yan H, Brooks D, Ladner R, et al. Arterialized venous flaps: a review of the literature
[J]. Microsurgery, 2010, 30(6): 472-478.
[2] Nguyen PSA, Legre R, Gay AM. Treatment of hand ischemia with arterialization of the venous of the hand: report of three cases
[J]. Ann Chir Plast Esthet, 2011, 56(3): 200-206.
[3] Matarrese MR, Hammert WC. Revascularization of the ischemic hand with arterialization of the venous system
[J]. J Hand Surg, 2011, 36(12): 2047-2051.
[4] Masden DL, Seruya M, Higgins JP. A systematic veview of the outcomes of distal upper extremity bypass surgery with arterial and venous conduits
[J]. J Hand Surg, 2012, 37(11): 2362-2367.
[5] Chen YC, Chan FC, Hsu CC, et al. Fingertip replantation without venous anastomosis
[J]. Ann Plast Surg, 2013, 70(3): 284-288.
[6] 江起庭, 杨丽娜, 王钰, 等. 静脉动脉化在手外科领域中的应用
[J]. 国际外科学杂志, 2013, 40(11): 734-736.
[7] Djoric P. Early individual experience with distal venous arterialization as a lower limb salvage procedure
[J]. Am Surg, 2011, 77(6): 726-730.
[8] Sasajima T, Azuma N, Uchida H, et al. Combined distal venous arterialization and free flap of patients with extensive tissue loss
[J]. Ann Vasc Surg, 2010, 24(3): 373-381.
[9] Djoric P, Zeleskov-Djoric J, Stanisavljevic DM, et al. Venous arterialization and reperfusion injury: focus on oxidative status
[J]. Eur Surg Res, 2012, 48(4): 200-207.
[10] Tygesen G, Matzen H, Grnkjaer K, et al. Mathematical arterialization of venous blood in emergency medicine patients
[J]. Eur J Emerg Med, 2013, 19(6): 363-372.
[11] Mutirangura P, Ruangsetakit C, Wongwanit C, et al. Pedal bypass with deep venous arterialization: the therapeutic option in critical limb ischemia and unreconstructable distal arteries
[J]. Vascular, 2011, 19(6): 313-319.
[12] 江起庭, 江志伟, 杨丽娜. 指侧方静脉在指尖离断再植中的应用
[J]. 中国修复重建外科杂志, 2013, 27(2): 215-252.
[13] 江起庭, 龚劲松, 朱刚, 等. 吻合指侧方静脉重建指尖再植回流的临床研究
[J]. 中华骨科杂志, 2013, 33(7): 719-722.
[14] Munz M, Amorim MJ, Faria M, et al. Cardiac venous arterialization in acute myocardial infarction: how great is the benefit
[J]? Interact Cardiovasc Thorac Surg, 2013, 16(3): 307-313.
[15] Lan WL, Lin WN, Bell D, et al. The physiology microcirculation and clinical application of the shunt-restricted arterialized venous flaps for the reconstruction of digital defects
[J]. J Hand Surg, 2013, 38(4): 352-365.
[16] Kawakatsu M, Ishikawa K, Sawabe K. Free arterialised flow-through venous anastomosis as the outflow(A-A-V flap) for reconstruction after severe finger injuries
[J]. J Plast Surg Hand Surg, 2013, 47(1): 66-69.
[17] Ishikawa K, Ogawa Y, Soeda H, et al. A new classification of the amputation level for the distal part of the finger
[J]. J Jpn Soc Microsurg, 1990, 3(1): 54-62.
[18] 江起庭, 杨丽娜, 王钰, 等. 双动脉式静脉动脉化再植断指
[J]. 中华医学杂志, 2013, 93(43): 3477-3480.
[19] 江起庭, 杨丽娜, 王钰, 等. 同指组合皮瓣修复拇指末节脱套伤34例
[J]. 中华烧伤杂志, 2013, 29(6): 571-572.
[20] 江起庭, 杨丽娜, 江志伟. 双端侧神经吻合修复双侧指固有神经陈性旧性损伤
[J]. 中华骨科杂志, 2012, 32(12): 1161-1165.
/
| 〈 |
|
〉 |
京ICP备08002354号-3
