吻合中央动脉中间支再植Yamano Ⅰ区指尖的临床应用

Clinical application of replantation of Yamano Ⅰ zone fingertip with anastomosis of central artery

目的 探讨吻合一条动脉的Yamano Ⅰ区指尖再植的临床效果和应用体会。方法 自2012年1月至2017年2月我们对无静脉可供吻合的Yamano Ⅰ区指尖离断采用仅吻合一条中央动脉再植21例。拔除指甲,术后不采用放血疗法。观察再植指体存活情况、指腹饱满度、手指外形和感觉恢复情况及并发症。结果 再植治疗21例21指均存活。术后随访10~36个月,平均15.9个月,患指外形满意,指腹饱满,无触、痛觉过敏,两点分辨觉为3-6mm,平均4mm,伤口及骨折端均Ⅰ期愈合,甲板生长良好,有3例指体轻度萎缩,患指关节活动均恢复良好。结论 采用仅吻合一条中央动脉的方法再植Yamano Ⅰ区指尖可获得满意的成活率,术后指腹饱满,感觉恢复良好,手术操作耗时短,值得临床推广。

Objective To investigate the clinical efficacy and the application experience of replantation of Yamano Ⅰ zone fingertip with anastomosis of one artery.Methods From January2012 to February2017,21cases of Yamano Ⅰ zone fingertip amputation without available vein for anastomosis were treated by replantation with only one central artery anastomosis.The nails were removed and blood-letting therapy was not used postoperatively.The survival rate,pulp fullness,finger appearance, sensory recovery and complications were observed.Results All the eases survived uneventfully. The follow-up period ranged from10to36months with an average of15.9months.The patients were satisfied with the appearance of fingers,full pulp and no hyperalgesia.The two-point uneventfully discrimination was3to6mm,averaging4mm.The wounds and fractures achieved primary healing. The appearance of nail was good.The mild finger atrophy occurred in3cases.The movements of the injured finger joints recovered well.Conclusion The replantation of Yamano I zone fingertip with only anastomosis of central artery can achieve satisfactory survival rate,full pulp and good recovery of sensation after the operation.The operation time is short.It is worthy of clinical promotion.