静脉动脉化再植断指新方法—双动脉式

目的 探讨双动脉式静脉动脉化再植断指的临床疗效.方法 2008年2月-2011年12月收治断指患者28例,均在正常指动脉多次吻合失败后行静脉动脉化.15例采用双动脉式静脉动脉化再植,将非优势侧指动脉近端端侧吻合于优势侧指动脉上,然后再将优势侧动脉的近端与远端静脉吻合（近、中节断指选指掌侧静脉,末节断指选指侧方静脉）.13例采用单式静脉动脉化再植,直接将优势侧指动脉近端与远端静脉吻合.结果 双动脉式静脉动脉化组全部成活,创面均一期愈合;单式静脉动脉化组4例坏死.24例获随访,随访时间6～14个月.双动脉式静脉动脉化组15例,指外形佳,指腹饱满,指体无明显萎缩;指甲生长平整,长度（15.4±3.2） mm,长于另一组;两点分辨觉（4.7±0.4） mm,小于另一组;感觉测定为S2～S4,平均为S3＋,高于另一组.参照Tamai评分标准：优11例,良4例,优良率100％,优良率与另一组比较差异有统计学意义（X 2 =7.219,P =0.027）.单式静脉动脉化组9例（坏死指除外）,指体轻度萎缩,指甲生长不平整,长度（12.2±2.3） mm;两点分辨觉（8.4±0.6） mm;感觉测定为S2～S3＋,平均为S2.参照Tamai评分标准：优4例,良3,可2例,优良率77.8％.结论 双动脉式静脉动脉化放大了单式静脉动脉化作用,迅速使瓣膜无创伤性失效,有效灌注多,明显提高再植指成活率,促进指甲生长及感觉恢复,增强指关节的活动,为正常方法失败后提供了一种更有效的补救方法.

A new method of veno-arteriolization of bilateral proper digital artery for repairing severed fingers

Objective To investigate effect of veno-arteriolization of bilateral proper digital artery for repairing severed fingers.Methods From February 2008 to December 2011,28 patients with severed fingers were admitted to our center,with veno-arteriolization after failure in anastomosing artery of finger over times.15 patients underwent veno-arteriolization of bilateral proper digital artery.During operation,the non-superiorty digital artery had been to end-to-side anastomose with the dominant digital artery,then the dominant digital artery proximal end and the digital vein distal end was anastomosed as the route of blood supply.13 patients underwent veno-arteriolization of single proper digital artery,the dominant digital artery proximal end and the digital vein distal end was directly anastomosed as the route of blood supply.Results All patients survived completely and achieved primary healing of wound after operation in veno-arteriolization of bilateral proper digital artery group; 4 fingers necrosis in veno-arteriolization of single proper digital artery group.Eighteen patients were successfully followed up for 6 to 14 months.In veno-arteriolization of bilateral proper digital artery group,15 patients were successfully followed up,the fingers had satisfactory appearance,finger pulp was plump with good flexibility,no obvious deformed growth of nail were found,and a sound recovery was obtained in the patients; the average result of length of nail was （15.4±3.2） mm which was significantly length than those of the other group; the average result of two point discrimination was （4.7±0.4） mm which was significantly lower than those of the other group; the average result of sensation measurement was S3＋ which was significantly higher than those of the other group; according to Tamai＇s classification,the results were excellent in 11 cases,good in 4 cases,with an excellent and good rate of 100,there were significant difference in results between the two groups （X 2=7.219,P =0.027）.In veno-arteriolization of