吻合单根动脉指尖再植侧支回流流体力学解析

Fluid mechanics analysis of collateral circulation in fingertip replantation with single artery anastomosis

目的研究末节指动脉侧支的解剖学特点，探讨吻合单根动脉指尖再植的侧支回流的流体力学机制。方法对10只新鲜成人尸体手标本进行乳胶灌注，显微解剖观测手指末节指动脉侧支的数量、侧支的外径．结合指动脉铸型标本观测侧支和主干的角度。用简易装置建立模拟吻合单根动脉指尖再植流体力学模型，观察模拟侧支回流现象。结果（1）指动脉末节侧支数为（12．7±3．2）支，侧支外径为（0．32±0．08）mm。约60．3％的末节指动脉侧支与主干的角度在30°～60°，指动脉弓处侧支角接近90°（2）从模拟指尖再植流体力学模型上观察到理想液体的模拟侧支回流现象。结论（1）在指尖再植术中应尽量保留指动脉吻合口近端侧支，尽量缩短指动脉吻合口与侧支的距离。（2）利用伯努利定律（ρgh±1／2ρv^2±P=C）分析指动脉侧支回流现象，这种现象是吻合单根动脉指尖再植成活的主要机制。

Objective To study the anatomical characteristics of finger arterial collateral in the distal fingers and analysis the phenomenon of fingertip replantation with single artery anastomosis of collateral return and investigate the Fluid mechanic. Methods Latex perfusion for 10 fresh cadavers hand specimen, observed the number and diameter of finger arterial collateral in the distal fingers by microsurgical anatomy, observed the angle of collateral and the trunk of the artery in finger artery cast specimens. Established a Fluid mechanic model of fingertip replantation with anastomosing a single artery by a simple device, and observed the phenomenon of collateral return. Results （1）The number of finger arterial collateral in the distal fingers was （12.7±3.2）. The external diameter was （0.32±0.08）mm. About 60.3% of the angle of between collateral in fingertip artery and the trunk was 30 °- 60°,the finger arterial arch collateral angle closed to 90 °. （2）Observed the phenomenon of ideal liquid collateral return from Fluid mechanic model of fingertip replantation consistent with a single artery. Conclusion （1）We should be kept the finger artery collateral of proximal anastomotic, shorten the distance of the finger arterial anastomotic to the collateral. （2）analysis the phenomenon of fingertip replantation with single anastomosis of collateral return by Bernoulli＇s law （ρgh±1/2ρv^2±P=C）, the phenomenon is the main mechanism of survival for fingertip replantation with single anastomosis.