手指末节血管神经的应用解剖

Topography of Distal Fingers

目的 研究指端血管神经的解剖特点 ,以提高末节断指再植成活率和成活后质量。方法 新鲜手指 35指 ,作手指末节血管神经显微解剖 ,观察血管神经的分布 ,测量不同水平血管的直径。结果 指腹螺纹中心为指端动脉弓体表最高点的投影 ,以螺纹中心为界把末节断指分为 3种类型 ,Ⅰ型为远侧指间关节横纹至甲根部 ;Ⅱ型为甲根至指腹螺纹中心 ;Ⅲ型为指腹螺纹中心以远端。远侧指间关节横纹至指腹螺纹中心的动脉直径为 0 .3～ 0 .6mm ,指背和指腹侧静脉直径为 0 .3～ 0 .8mm。螺纹中心以远的指动脉呈分支状 ,直径在 0 .1～ 0 .3mm ,静脉约 0 .15～ 0 .3mm。结论 末节指血管神经的分布有其特点 ,指腹螺纹中心可作为指端动脉弓的体表标志 ,末节断指都应尽可能地再植。

Objective To study the severed distal segment of fingers and increase the survival rate of replantation. Methods The distributions of blood vessels and nerves in the distal segment were observed under microscope using 35 mutiated fingers. The diameter of blood vessels at different levels were noted. Results The center of swirling fingerprint is the landmark of body surface of arterial arch of fingertip. Severance of the distal segments could be classified into 3 types centered at the center of swirling fingerprint: type Ⅰ, between the distal interphalangeal joint and nail root; type Ⅱ, between the nail root and the center of swirling fingerprint; and type Ⅲ, distal to the center of swirling fingerprint. Conclusion The severed distal segment of fingers in type Ⅰ and type Ⅱ should be replanted under microscope at 10x magnification. The vessels of fingers in type Ⅲ should be anastomosed under 16x magnification.