健康人群A1滑车高频超声测值及其影响因素分析

  目的  探讨健康人群屈指肌腱A1滑车厚度及其影响因素。  方法  应用高频超声观察90例健康人双侧手指屈指肌腱的10个A1滑车的声像图,并测量其厚度,同时记录每个人的性别、年龄、身高、体质量及体质量指数。分析手指A1滑车厚度的影响因素。  结果  高频超声能够清晰显示A1滑车结构;双侧手指A1滑车厚度差异无统计学意义（P>0.05）。正常各手指A1滑车厚度差异有统计学意义（P<0.05）,进一步比较发现A1滑车厚度可分为两个子集:拇指和小指〔（0.196±0.051） mm〕、食指中指和环指〔（0.230±0.055） mm〕,前者厚度较后者薄;A1滑车厚度与年龄正相关（r=0.468,P<0.001）。拇指与小指在<19岁、20～49岁、≥50岁的正常参考值范围分别为0.09～0.23 mm、0.12～0.30 mm、0.12～0.32 mm;食指、中指及环指在<19岁、20～49岁、≥50岁的正常参考值范围分别为0.11～0.27 mm、0.15～0.35 mm、0.17～0.35 mm。不同性别、不同体质量指数的A1滑车厚度差异无统计学意义（P>0.05）。  结论  A1滑车厚度的影响因素为部位、年龄。高频超声可以清晰观察及测量A1滑车,成为A1滑车病变定量评价的候选手段。     

烧伤残存示指移位再造拇指术

目的：对严重烧伤残缺手，通过改良的残存示指移位再造拇指，避免术中拇指血运障碍和术后肿胀。方法：保留残存示指桡侧疤痕皮肤和周围组织，仅在示、中指指蹼间作纵形切口，分离截断示指掌骨，然后旋前位移向拇指。结果：15例16指残存示指移位再造拇指术，无一例发生术中血运障碍和术后肿胀。结论：在严重烧伤残存手采用该手术方法避免再造拇指的血运障碍和术后肿胀，手术操作简易。     

游离第二足趾移植一期修复拇指和手指缺损

目的观察急诊应用游离第二足趾（或）带足背皮瓣移植。一期修复拇指和手指缺授的临床疗效。方法对本组67例共83指不同程度拇指、示指和中指的缺损，急诊游离第二足趾（或）带足背皮瓣移植，通过不同的动脉和静脉吻合方式，重建血液循环，改进骨的内固定方法和肌腱吻夸方法，再造拇指和手指。结果所有再造指均全部成活，无一例患者出现肌腱断裂和骨不连。走部分病例获得随访6个月～5年，再造指外形皿功能良好，末梢感觉二点分辩率为5～12mm。供区所植的皮片均成活，感觉和外观令人满意。供足术后2～3个月可恢复正常的行走、负重功能。结论急诊游离第二足趾移植再造拇、手指具成活率高的优点，是值得广泛开展的修复手指缺顿的有效方法。     

An atypical anatomical variation of palmar vascular pattern

A complex variation in the pattern of blood supply to the palm of the hand was encountered during a routine dissection of a female adult cadaver. Findings were: (a) there was no communication between the superficial palmar branches of the radial and ulnar arteries (incomplete superficial palmar arch); (b) the superficial palmar branch of the radial artery coursed superficially to the thenar muscles supplying two common palmar digital arteries for adjacent sides of the thumb and index finger, thereby replacing the conventional arteria radialis indices; (c) the branch supplying the lateral side of the thumb was seen arising from the deep branch of the radial artery; (d) the superficial palmar branch of the ulnar artery supplied a branch to the medial side of the little finger, and two common palmar digital arteries for the adjacent sides of the little and ring fingers and ring and middle fingers, respectively. Familiarity with the variations in the vascular patterns resulting from a number of developmental errors remains the crucial issue for personnel engaged in reconstructive hand surgery, where these varied patterns act as pivotal points around which successful accomplishment of various advanced surgical procedures revolve.     

Sensory action potentials of ring finger in the diagnosis of carpal tunnel syndrome

Amplitudes and latencies of sensory action potentials (SAPs) recorded over the index, middle, little and ring fingers by antidromic stimulation of the median or ulnar nerve at wrist were measured in 65 normal adults and 78 patients with clinically and electrophysiologically verified carpal tunnel syndrome. In the normal adults, there was no significant difference among the SAP latencies of the index, middle, ring and little fingers. Among these 65 normal adults, the difference between median and ulnar SAPs of ring finger was less than 0.4 msec in 64 subjects, but 0.7 msec in one. In the patient group, the median distal sensory latency of the ring finger was significantly longer than that of the ulnar nerve which was recorded over the ring and little fingers. Six cases (7.7%) of 78 patients diagnosed as CTS by conventional electrophysiological studies was false negative by using the ring finger sensory action potential study. It is suggested that the SAP study of the ring finger by stimulation of the median and ulnar nerves at the wrist can not replace the conventional electrodiagnostic methods for the diagnosis of carpal tunnel syndrome.     

甲床扩大术治疗指端损伤36例临床分析

目的总结甲床扩大术在指端损伤治疗中的经验。方法自2003年9月至2007年5月,对36例指端损伤伴指甲缺损患者行甲床扩大术,其中拇指15例、食指10例、中指8例、环指3例,年龄16～45岁（平均26岁）。在距甲根皮缘5～6mm处,去除长为2～3mm、宽与指甲相等的矩形皮肤,勿损伤皮下血管网,将“U”形皮瓣向近端轻柔推剥并缝合。结果术后经过均顺利,随访6个月～3年（平均19个月）,指甲外形较好,取得较满意的临床效果。结论甲床扩大术能改善拇指等手指的外形,是简单、有效的手术方法。     

单足供趾再造手技术的改进

目的 报道单足供趾再造手技术的改进及其临床应用结果。方法 对60只成人足标本进行解剖学研究。设计游Mu趾甲瓣及相邻的第2或第2和第3足趾的新方法，在临床上实施单足供趾再造拇指及其他两个手指。结果 解剖学研究证实，只要足背动脉存在，就能以第1跖背（底）动脉-第2跖背（底）动脉为蒂游离Mu趾皮肤趾甲瓣及相邻的第2或第2和第3足趾；分别用于再造拇指，食指和中指及拇指，中指和环指，均取得成功。结论 单足供趾再造手技术的改进能扩大手术适应证，并可提高再造手的功能。     

METHOD OF RECONSTRUCTING THUMB, INDEX AND/OR MIDDLE FINGER FOR DIGITLESS HANDS

The authors have designed a new technique of reconstruction of thumb and finger for a fingerless hand using one donor foot. Based on the common pedicle of the dorsalis pedis artery and the saphe nous vein, the big toe skin-nail flap, the adjacent se cond or the second and the third toes are transplant. ed to reconstruct the thumb, the index or the thumb, the index and the middle fingers. The phalanx of the reconstructed thumb is an iliac block. This ar ticle reports three cases with very good results. The loss of one or two toes does not impair the jumping ability of the donor foot.     

两种岛状瓣修复拇指末端缺损的临床疗效分析

目的：分析及比较示指背侧神经血管蒂岛状瓣与带神经拇指尺背侧动脉逆行岛状瓣修复拇指末端缺损的临床效果。方法选取2005年1月-2013年1月期间莆田学院附属医院和广东省电白县医院收治的114例拇指末端缺损的患者,根据患指的受伤情况分别采用两种手术方法修复,采用示指背侧蒂岛状瓣55例,采用带神经拇指尺背侧动脉逆行岛状瓣59例,术后随访6个月~2年。结果2组患者术后屈伸功能、耐寒性、皮瓣的两点辨别觉、皮瓣感觉恢复差异均无统计学意义。结论示指背侧神经血管蒂岛状瓣和带神经拇指尺背侧动脉逆行岛状瓣均是修复拇指末端缺损的良好方法,值得推广。     

中环、指中节逆行C型皮瓣修复拇、食指末节脱套伤

C型皮瓣是目前修复手指末节脱套伤的一种较为先进的方法。我院1999年5月~2002年9月应用中指、环指中节逆行C型皮瓣修复拇指、食指末节脱套伤9例,所有皮瓣均成活,外形满意。此方法易行、简便,术后断蒂早。但范围局限,感觉较差,对供指外观有一定影响。     

中环、指中节逆行C型皮瓣修复拇、食指末节脱套伤

C型皮瓣是目前修复手指末节脱套伤的一种较为先进的方法。我院1999年5月-2002年9月应用中指、环指中节逆行C型皮瓣修复拇指、食指末节脱套伤9例，所有皮瓣均成活，外形满意。此方法易行、简便，术后断蒂早。但范围局限。感觉较差，对供指外观有一定影响。     

双叶指动脉岛状皮瓣修复拇指掌侧软组织缺损临床分析

目的：探讨带神经双叶指动脉岛状皮瓣修复拇指掌侧大面积软组织缺损的效果。方法：根据14例拇指掌侧大面积软组织缺损创面的大小,在中指尺侧、环指桡侧设计带神经双叶指动脉岛状皮瓣转移修复患处,供区创面植皮修复。结果：14例皮瓣全部存活。随访1～38个月手指外形满意,感觉、功能良好。结论：应用中指尺侧环指桡侧带神经双叶指动脉岛状皮瓣修复拇指掌侧大面积软组织缺损创面,克服了常见皮瓣的缺点,且具有设计合理、切取转移方便、供受区邻近组织结构合理、修复后外形满意等优点。     

5种带皮神经的岛状皮瓣修复拇指指腹软组织缺损

目的探讨5种带皮神经的岛状皮瓣修复拇指指腹软组织缺损的手术方法及临床效果。方法采用拇指尺或桡背侧皮神经伴行血管岛状皮瓣、示指背侧岛状皮瓣、中指尺侧或环指桡侧指神经血管蒂岛状皮瓣修复拇指腹缺损28例,皮瓣均含有感觉神经,皮瓣切取的最大面积5.5 cm×3 cm。结果28例皮瓣全部成活,经6~12个月随访,拇指指腹外形及感觉功能恢复优良,指腹两点辨别觉5~12 mm。结论严格选择适应证,5种带感觉神经的皮瓣血供可靠,操作简单,可较好的恢复拇指指腹的外形和感觉。     

OPERATIVE TECHNIQUE 8F POLLXCXZATXON UTILIZXNG FINGER STUMPS

In cases of complete absence of the thumb or severance through the lst metacarpal as- sociated with partial defects of t.he fingers, the thumb may be reconstructed by means of trans- planting one of the defected fingers according to the conditions of the in.jury. The tFtumb thus reconstructed has a suitable length and an ac- ceptable appearance as well as a good sensation and a certain amount of movement. The operative technique of pollicization using the 2nd metacarpal and the stump of the index, middle and ring fingers is discussed in detail in tliis article with case reports and dia- grams of the operative technique.     

Reconstructions of fingertip and polydigital crush injuries with island and random flaps：a case report

A 42-year-old male labourer working in a harbor injured both his hands in a steel rolling device. In the left non-dominant hand the index finger, middle finger and ring finger had crush injury. The right dominant hand had a crush amputation of the tip of the middle finger. In the left hand the ring finger was severely crushed and was not amenable to salvage. The index finger and middle finger was also crushed and had comminuted fractures up to the middle phalanx which was diagnosed by a plain X-ray. The little finger sustained minor soft tissue loss in the fingertip.     

拇手指部分缺损的修饰性修复与重建

目的评估对拇、手指末节部分缺损,选用相应部分足趾组织移植修饰性修复与重建的临床效果,提出修饰性修复与重建的新理念。方法对77例80指拇、手指末节半侧、背侧、指腹及手指部分复合组织缺损选用足趾末节半侧甲瓣,背侧甲瓣,趾腹皮瓣及足趾相应部分复合组织移植,采用吻合趾．指动静脉重建血液循环,施行修饰性修复与重建。结果成活75例78指,成活率为97．5％,术后经半年至12年随访,保持了手指原来长度与外形,重建了指甲,使指腹饱满,具有罗纹,出汗,两点分瓣觉为4～6mm,获得较完美的外形与功能。结论对拇、手指末节部分复合组织缺损,选用相应部分足趾半侧甲瓣、背侧甲瓣、趾腹皮瓣及复合组织移植的修饰性修复与重建,可达到精细修复效果和修饰性修复与重建的目的。     

仫佬族指纹白线的研究

目的研究仫佬族指纹白线的特征。方法对仫佬族309名学生手指指纹白线进行观测和统计分析。结果①各指指纹的白线出现率为:男7.58%、女8.84%,性别间差异无显著性。②指纹白线在各手指的出现率按拇指>中指>食指>小指>无名指的顺序排列。③左手指纹白线出现率为4.69%,高于右手3.62%,左、右手间差异有显著性。④仫佬族指纹白线的阳性手指分布以1~4指为常见,指纹白线条数分布以1~5条为多见。结论仫佬族指纹白线出现率在国内人群中处于偏低水平。     

四川凉山20-30岁彝族人群指长与身高的相关性研究

目的研究四川凉山彝族人群指长与身高的相关关系。方法按照人体骨骼测量方法,测量208例(男151,女57)20-30岁四川彝族健康成年人左手五指长度、五指末端指节长度及身高。结果与结论男性左手10个测量指标与身高均有显著相关性,其中中指长与身高相关性最大(r=0.372)。女性只有食指长、中指长、环指长、小指长及食指末节长与身高有显著相关性,以食指末节长与身高的相关性最大(r=0.454)。     

手指皮肤缺损修复效果观察

目的:观察手指皮肤缺损的修复效果。方法:对32指手部不同部位的皮肤缺损采用了不同的皮瓣修复。其中皮神经岛状皮瓣逆行转位重建拇指感觉功能16指,中指尺侧岛状皮瓣加示指背侧岛状皮瓣转位修复拇指套脱伤2指,中环指岛状皮瓣转位修复拇指撕脱伤4指,以手指一侧指背动脉为轴转位修复手指掌侧近中节皮扶缺损10指。结果:除有一例拇指皮肤边缘部分坏死外,其余全部成活。经随访6个月-7年,拇指及指掌侧皮瓣的质地、外观、功能、长度和感觉良好。结论:皮神经岛状皮瓣逆行转位,中指尺侧岛状皮瓣加示指背侧岛状皮瓣转位,中环指岛状皮瓣及指背皮瓣转位修复拇指损伤及手指掌侧近中节皮肤缺损,方法简单、可靠,手指的外观、感觉、功能满意。     

吻合神经的拇指尺背侧皮神经筋膜蒂岛状皮瓣修复示指末节软组织缺损

目的观察应用吻合神经的拇指尺背侧皮神经筋膜蒂岛状皮瓣修复示指末节桡侧软组织缺损的临床效果。方法对15例示指末节桡侧软组织缺损病例,采用拇指尺背侧皮神经筋膜蒂岛状皮瓣,逆行移位至拇指近节近端尺侧,屈曲示指末节贴紧拇指近节尺侧固定,吻合拇指尺背侧皮神经与示指桡侧指固有神经,皮瓣带蒂修复创面,2、3周后断蒂。结果皮瓣全部成活,随访6～24个月,皮瓣质地柔软、弹性好、耐磨;指端饱满,色泽正常,两点辨别觉6.4￣9.6mm,11例感觉恢复至S3,4例至S4,外观及功能满意。结论应用吻合神经的拇指尺背侧皮神经筋膜蒂岛状皮瓣,术后效果良好,是修复示指末节桡侧软组织缺损较理想的手术方法。