改良血管套接法对断指再植患者断指成活和微循环的影响

Effect of Modified Vascular Cuff Grafting on the Survival and Microcirculation of Severed Fingers in Patients with Replantation of Severed Fingers

目的:探讨断指再植患者应用改良血管套接法对断指成活和微循环的影响。方法:回顾性分析2020年1月—2022年1月福州海福手外科医院收治的80例手指离断伤患者的资料,根据不同手术方式分为观察组(n=37,在断指再植术中选择改良血管套接法作为手术方案)和对照组(n=43,在断指再植术中选择血管端端吻合术作为手术方案)。比较术后1、3、5 d两组再植指微循环血运情况[再植指的毛细血管充盈时间(CRT)、再植指微循环测量值、经皮氧分压(TcPO_(2))、经皮血氧饱和度(SpO_(2))],比较术后7 d两组的再植指成活情况(再植指成活率、再植指颜色正常率与再植指张力正常率)。结果:术后1、3、5 d,两组CRT、再植指微循环测量值逐渐下降,且观察组的CRT短于对照组,再植指微循环测量值明显低于对照组(P<0.05),两组的TcPO_(2)、SpO_(2)水平逐渐提高,且观察组的TcPO_(2)、SpO_(2)水平均高于对照组(P<0.05)。观察组术后7 d再植指成活率、颜色正常率及张力正常率均高于对照组(P<0.05)。结论:在断指再植术中应用改良血管套接法可以更好地减少患指CRT,改善再植指微循环情况,提升再植指TcPO_(2)与SpO_(2),从而促进肢体功能尽快恢复。

Objective:To investigate the effect of modified vascular cuff grafting on the survival and microcirculation of severed fingers in patients with replantation of severed fingers.Method:The data of 80 patients with severed fingers admitted to Fuzhou Haifu Hand Surgery Hospital from January 2020 to January 2022 were analyzed retrospectively.According to different surgical methods,they were divided into the observation group(n=37,the modified vascular cuff grafting method was selected as the surgical scheme in the replantation of severed fingers)and the control group(n=43,the vascular end-to-end anastomosis was selected as the surgical scheme in the replantation of severed fingers).The microcirculation blood supply of replanted fingers[capillary refill time(CRT)of replanted fingers,microcirculation of replanted fingers,transcutaneous oxygen pressure(TcPO_(2))and transcutaneous oxygen saturation(SpO_(2))]were compared between the two groups at 1,3,5 d after operation.And the survival condition of replanted fingers(survival rate of replanted fingers,normal color rate of replanted fingers and normal tension rate of replanted fingers)were compared between the two groups at 7 d after operation.Result:At 1,3,5 d after operation,the CRT and measured values of microcirculation of replanted fingers in the two groups decreased gradually,and the CRT in the observation group was shorter than that in the control group,and the measured values of microcirculation of replanted fingers were significantly lower than those in the control group(P<0.05);the levels of TcPO_(2)and SpO_(2)in the two groups were gradually increased,and the levels in the observation group were higher than those in the control group(P<0.05).Seven days after operation,the survival rate,normal color rate and normal tension rate of replanted fingers in the observation group were higher than those in the control group(P<0.05).Conclusion:Modified vascular cuff grafting method in replantation of severed fingers can better reduce CRT of affected fingers,improve the microcirculation of the replanted fingers,and improve the TcPO_(2)and SpO_(2)of the replanted fingers,so as to promote the recovery of limb function as soon as possible.