双动脉式指侧方静脉动脉化于末节断指再植中应用

摘要

Objective To investigate effect of veno-arteriolization of finger lateral vein with bilateral proper digital artery for repairing distal severed fingers .Methods From February 2011 to June 2013,37 patients with distal severed fingers were admitted to our center ,with veno-arteriolization of finger lateral vein after failure in anastomosing artery of finger over times .20 patients underwent veno-arteriolization of finger lateral vein with bilateral proper digital artery (group A).17 patients underwent veno-arteriolization of fin-ger lateral vein with single proper digital artery (group B),the dominant digital artery proximal end and the finger lateral vein distal end was directly anastomosed as the route of blood supply .Results All patients survived completely and achieved primary healing of wound after operation in group A;6 fingers suffered necrosis in group B .31 patients (20 patients in group A,11 patients in group B) were suc-cessfully followed up for 4 to 8 months,with an average time of (6.2 ±1.6) months.According to Tamai’s classification,the excellent and good rate was 100%in group A,the excellent and good rate was 63.6%in group B.The significant difference was found between the two groups (P<0.05).Conclusion The veno-arteriolization of finger lateral vein with bilateral proper digital artery is a valuable method for repairing distal severed fingers .%目的：探讨双动脉式指侧方静脉动脉化再植末节断指的临床疗效。方法2011年2月-2013年6月收治断指37例，均在正常指动脉多次吻合失败后行指侧方静脉动脉化。20例采用双动脉式指侧方静脉动脉化再植（ A组），17例将非优势侧指固有动脉近端端侧吻合用单式指侧方静脉动脉化再植（B组），直接将优势侧动脉近端与指侧方静脉远端吻合。结果 A组病例全部成活，创面均一期愈合；B组6例坏死。所有断指成活病例（31例）均在术后4～8（6．2±1．6）个月随访。参照Tamai评分标准，A组再植手指优良率100．0％，B组优良率63．6％，两组比较差异有统计学意义（P＜0．05）。结论双动脉式指侧方静脉动脉化放大了单式指侧方静脉动脉化作用，迅速使静脉瓣膜无创伤性失效，提高再植指成活率，促进指甲生长及感觉恢复，增强指关节活动度，为正常供血多次失败后的断指再植提供了一种更有效的补救方法。