尺侧指固有动脉与桡动脉腕背支桥接的断拇再植

目的:介绍一种治疗近端动脉严重损伤的拇指离断再植术的方法,并评价其疗效。方法:2007年2月至2009年3月,采用前臂掌侧静脉移植,桥接鼻咽窝处桡动脉腕背支与尺侧指固有动脉的远侧断端,治疗13例近端动脉严重损伤的拇指离断。男11例,女2例;年龄16～50岁,平均34.5岁。左侧7例,右侧6例。完全离断8例,不全离断5例。急诊再植10例,按常规步骤再植术后动脉危象探查修复3例。结果:13例拇指全部成活。所有患者获得随访,时间8～17个月,平均11个月。再植拇指外形满意,根据中华医学会手外科学会断指再植功能评定试用标准:优9指,良3指,差1指。指腹两点辨别觉58mm,平均6.5mm。结论:静脉移植桥接鼻咽窝桡动脉腕背支与尺侧指固有动脉远端的方法修复拇指动脉,行复杂拇指离断再植,手术体位舒适,不影响手部血供,扩大了再植适应证,提高了再植成功率。

Thumb replantation through bridging ulnar proper digital artery and dorsal carpal branch of radial artery

Objective: To introduce treatment method of replantation of severed thumb trauma with proximal arterial,and to evaluate its efficacy. Methods:From February 2007 to March 2009,13 patients with severed thumb in serious injury of proximal arterial were treated with vein graft of volar forearm,bridging between dorsal carpal branch of radial artery on nasopharyngeal fossa and distal stump of ulnar proper digital artery. Among them,there were 11 males and 2 females with an average age of 34.5 years ranging from 16 to 50 years. Seven cases were in the left thumb,6 in the right thumb. Eight cases were complete separation,incomplete separation in 5 cases. Ten cases recieved emergency reimplantation,3 cases with the arterial crisis after conventional replantation were explorated and repaired. Results:Thumb of 13 cases all survived. All patients were followed-up for 8 to 17 months (averaged,11 months). Replantation thumb obtained satisfactory appearance. According to Chinese Medical Association Society of Hand Surgery Trial criteria,the results were excellent in 9 fingers,good in 3 fingers,1 poor finger. Two point discrimination of finger pulp was 5 to 8 mm (averaged 6.5 mm). Conclusion:By repairing artery of thumb with vein graft of volar forearm,bridging between dorsal carpal branch of radial artery on nasopharyngeal fossa and distal stump of ulnar proper digital artery,complex severed thumb replants on surgery position comfortable,without affecting the blood supply of the hand,expanding the indications for replantation and improving the success rate of replantation.