指侧方静脉动脉化再植末节断指

目的：探讨指侧方静脉动脉化再植末节断指的疗效。方法2007年3月至2012年4月，收治末节断指患者34例，均在正常指动脉多次吻合失败后行静脉动脉化。20例采用指侧方静脉动脉化再植，将近端指动脉与远端指侧方静脉吻合（A组）；14例采用指腹静脉动脉化再植，用近端指动脉与远端指腹静脉吻合（B组）。结果 A组患者末节断指全部成活，创面均Ⅰ期愈合；B组中有4例坏死。本组中有27例随访6～14个月（A组18例，B组9例）。 A组再植末节断指指腹饱满，指体无明显萎缩，B组指体轻度萎缩；A组指甲长度（15.6±2.7） mm，长于B组（11.9±2.2） mm；A组DIPJ活动度（62±4）°，大于B组（45±3）°；A组两点分辨觉（4.6±0.3） mm，小于B组（7.4±0.6） mm；A组再植断指感觉测定为S（3.49±0.33），高于B组S（2.47±0.44）；手指各关节活动度参照TAM标准：A组优良率94.4%，B组优良率87.5%，两组优良率比较差异无统计学意义（P=0.534）。结论指侧方静脉动脉化是正常供血失败后的末节断指再植的有效方法。

Veno-Arteriolization of Finger Lateral Vein for Replanting Severed Finger Tips

Objective To investigate the effect of veno-arteriolization of finger lateral vein for replanting severed finger tips. Methods From March 2007 to April 2012, thirty-four patients with severed finger tips were admitted, and operated with veno-arteriolization after failure in arterial anastomosis over times. Twenty patients underwent veno-arteriolization of finger lateral vein, with the digital artery proximal end and the finger lateral vein distal end anastomosed. 14 patients underwent veno-arteriolization of finger pulp vein, with the proximal digital artery and distal finger pulp vein anastomosed. Results All patients survived completely and achieved primary healing of wound in group A;4 fingers ’ necrosis was observed in group B. Twenty-seven patients （18 patients in group A, 9 patients in group B） were successfully followed up for 6 to 14 months. In group A, the finger pulp was plump with good flexibility, no obvious atrophy was observed. But mild atrophy was observed in group B;The average length of nail was （15.6±2.7） mm in group A which was longer than that of group B （11.9±2.2） mm];The average motion of DIP joint was （62±4） ° in group A which was larger than that of group B （45±3） °];The average two point discrimination was （4.6 ±0.3） mm in group A which was lower than that of group B （7.4 ±0.6） mm]; The average sensation measurement was S （3.49±0.33） which was higher than that of group B S （2.47±0.44）];According to TAM scale, the good rate was 94.4% in group A and 87.5% in group B, there were no difference between the two groups （P=0.534）. Conclusion The veno-arteriolization of finger lateral vein is a valuable method for the replantation of severed finger tips.