仅吻合动脉的指尖再植血液回流方式探讨

摘要

Objective To investigate the way of blood reflux by only anastomosing the artery of separated fingertip and its clinical value. Methods Using microscope to debride throughly, then found the artery and the nerve. It was fixed the phalange by kirschner wire, and replanted through repairing the artery and the nerve. After the surgery, rebuild the balance of the blood circulation by nail excision bloodletting, medullary cavity exudation refluxing, arterial pressure difference. Results We had finished 28 cases of the replantation, 35 fingers. All of the cases were followed up for 6 to 36 months. 32 fingers were success and 3 fingers were failed. The survival rate was 91.4%. The peripheral microcirculation of the replanted tips was normal and the finger pulp grew well. The pain and warm sense recovered well. Two-point-discrimination could reach 5~7 mm. Conclusion The replantation of the fingertip only by anastomosing the artery can be successful, when we rebuild the balance of the blood circulation by nail excision bloodletting, medullary cavity exudation refluxing, arterial pressure difference refluxing.%目的：探讨仅吻合动脉的指尖离断再植的血液回流方式及其临床价值。方法2004年4月-2014年12月，对离断指尖在显微镜下行彻底清创，找出指动脉、指神经，克氏针固定指骨，修复动脉和指神经，术后通过拔甲放血、骨髓腔渗血回流、动脉压力差回流重建血液循环平衡。结果临床再植28例35指，成活32指，3指坏死，成活率91.4%。术后随访6～36个月，成活指指甲生长良好，无畸形，指腹饱满，痛、温觉恢复，两点辨别觉达5～7 mm。结论仅吻合动脉的指尖再植可以通过拔甲放血、骨髓腔渗血回流、动脉压力差回流三种方式重建血液循环平衡，提高指尖再植成功率。