不同方法重建指尖离断静脉回流的疗效分析

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2；22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1；20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍；吻合指腹静脉组19例发生静脉危象,其中4例手指坏死；未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满；吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整；未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组（14.4±3.2）mm比（12.5±2.3）mm和（12.2±2.2）mm],远侧指间关节活动度大于其他两组（63±5）°比（48±3）°和（45±7）°],两点分辨觉小于其他两组（4.6±0.4）mm比（7.1±1.2）mm和（7.3±0.6）mm],感觉级别高于其他两组S（3.45±0.39）级比S（2.57±0.42）级和S（2.55±0.49）级],差异均具有显著性（P〈0.05）。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义（P〉0.05）。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。

Comparative analysis of effect of different methods of reconstruction of venous return of severed fingertip

Objective：To investigate the effect of different methods on reconstruction of venous return of severed fingertip. Methods：From March 2008 to February 2013,80 patients with severed fingertip were admitted to the Department of Hand Sur-gery. Among the 80 patients,38 patients underwent anastomosis of lateral veins of the finger,the ratio of artery：vein was 1：1,1：2 or 2：2,with mean proportion of 1：2;22 patients underwent anastomosis of finger pulp veins,the anastomotic ratio of artery：vein was 1：1;20 patients underwent anastomosis of one artery without anastomosis of veins,followed by bleeding from the nail bed or lateral-incision of finger. Results：All fingertips survived completely without venous obstruction in lateral veins an-astomosis group;1 9 fingers showed return obstruction,and necrosis occurred in 4 fingers in anastomosis of finger pulp veins group;return obstruction occurred in 20 fingers and necrosis occurred in 6 fingers in the group without vein anastomosis. Fifty-eight patients were followed up for 6 to 28 months. In 32 patients the appearance was satisfactory,finger pulp was plump,with-out deformity of nail in the group with anastomosis of lateral veins. Fourteen patients in finger pulp veins anastomosis group showed mild atrophy of the fingers;significant atrophy of the fingers was found in 12 patients in non-anastomosis group. The mean length of nail,mobility of distal interphalangeal j oint,two point discrimination,and sensation were better in lateral veins anastomosis group （14.4±3.2）mm,（63±5）°,（4.6±0.4）mm,S（3.45±0.39）]. The result was significantly better than those in finger pulp veins anastomosis group （12.5±2.3）mm,（48±3）°,（7.1±1.2）mm,S（2.57±0.42）],and in the group without vein anastomosis （12.2±2.2）mm,（45±7）°,（7.3±0.6）mm,S（2.55±0.49）;P〈0.05]. There was no significant difference in length of nail,mobility of distal interphalangeal j oints,two point discrimination,and sensory measurement between the latter tw