拇指旋转撕脱离断指体运用虎口动脉和邻指动脉转位重建血运的临床效果观察

摘要

目的：对患者分别采用虎口动脉转位重建血运和邻指动脉转位重建血运的手术方法对患者离断指体进行再植，并对两种方法的疗效及预后情况进行比较。方法2013年1月至2015年3月经我院急诊科收治并转入创伤骨科拇指旋转撕脱离断21例患者，对患者分别采用虎口动脉转位重建血运和邻指动脉转位重建血运的手术方法对患者离断指体进行再植。结果虎口动脉组手术时间为3.1~6.4 h，平均（3.4±1.2）h；邻指动脉组手术时间为4.2~7.3 h，平均（5.7±1.4）h。21例患者手术全部成功，断指全部成活。所有患者获得随访，随访时间为5~10个月，平均（7.7±0.5）个月。根据中华医学会手外科学会断指再植功能评定使用标准对所有患者手术情况进行评价，虎口动脉组优良率为72.7%；邻指动脉组优良率为70.0%。两组患者手术时间比较，差异有统计学意义（t=-4.054，P=0.001）。两组患者功能评价比较，差异无统计学意义（χ2=0.095，P=0.953）。结论虎口动脉转位重建血运和邻指动脉转位重建血运的手术方法疗效相近，前者手术时间短、创伤小。%Objective To compare the curative effectiveness and prognosis of two re⁃plantations:trans⁃position reconstruction of blood supply using Hukou arteries and adjacent finger arteries for severe amputated fingers. Methods From January 2013 to March 2015, re⁃plantations were carried out on 21 patients with rotated and avulsed injury of thumb admitted on by our hospital, respectively by transposition reconstruction of blood supply with Hukou arteries[Hukou artery group, 11 cases in total, 7 cases of males, 4 cases of females, aged 22 to 34 years old, (28.9±8.2 years) on average]and adjacent finger arteries[adjacent finger artery group, 10 cases in total, 6 cases of males, 4 cases of females, aged 21 to 32 years old, average (24.1±9.5 years) on average]. Results In Hukou artery group, the operating time was (3.1⁃6.4) h[(3.4±1.2) h on average], and in adjacent artery group, the operating time was (4.2⁃7.3) h[(5.7±1.4) h on average]. All surgical operations were performed successfully on 21 cases. All amputated fingers survived. All patients were followed up for 5⁃10 months[(7.7 ± 0.5) months on average]. According to the Chinese Medical Association⁃issued function assessment standard, excellent and good rate in Hukou artery group was 72.7%, and that in adjacent finger artery group was 70.0%. There was significant difference in the operating time between two groups (t=4.054, P=4.054), but no significant difference was found in the function assessment between two groups (χ2=0.095, P=0.095). Conclusion Transposition reconstruction of blood supply by Hukou arteries and adjacent arteries has almost the same outcomes, while the former one has shorter operating time, and more minimally trauma.