密闭包扎法与指动脉岛状皮瓣治疗指端缺损的临床疗效比较

Comparison of occlusive dressing technique and digital artery island flaps in the treatment of fingertip defects

目的 评价并比较密闭包扎法与指动脉逆行岛状皮瓣治疗指端组织缺损的临床疗效.方法 回顾性分析2012年6月-2014年6月,应用密闭包扎法与指动脉逆行岛状皮瓣治疗的80例指端组织缺损患者资料.根据治疗方式不同分为：包扎组45例和皮瓣组35例.比较两组的手术时间、住院时间、治疗费用、指端感觉恢复以及指间关节活动度.结果 所有患者术后获得6-24个月（平均13个月）随访.两组患者均未发生感染及皮瓣坏死.包扎组手术时间、住院时间、治疗费用均明显少于皮瓣组,差异均有统计学意义（P〈0.01）.术后6个月远指间关节、近指间关节活动度均优于皮瓣组,差异均有统计学意义（P〈0.01）.术后6个月两点辨别觉：包扎组（6.2±1.0）mm,皮瓣组（7.8±1.1）mm,差异有统计学意义（P〈0.01）.根据总主动活动度（TAM）法评定末次随访时手指功能,优良率：包扎组93.3%,皮瓣组91.4%,差异无统计学意义（P=0.06）.结论 在治疗指端组织缺损方面,密闭包扎法较指动脉逆行岛状皮瓣具有操作简单、花费少、临床效果好的优势,是一种较为理想的治疗方法.

Objective To evaluate and compare the clinical efficacy of using occlusive dressing technique and artery island flaps in treatment of fingertip defects. Methods From June 2012 to June 2014, 80 cases of fingertip defects were treated by using occlusive dressing technique or artery island flaps,including 45 males and 35 females with an average age of 45.6 years （aged 13-72）. Divided according to the different treatment： dressing group 45 cases and flap group 35 cases. Two groups were compared in operative time, hospital stay, cost of treatment, recovery of fingertip feel and interphalangeal joint motion. Results All the cases were followed up for 6 to 24 months（averaged 13 months）. All the 80 cases healed without infections or skin flap necrosis. The operative time, hospital stay, treatment costs of dressing group were significantly less than the flap group. When followed up after 6 months, the range of activities of distal interphalangeal joint and proximal interphalangeal joint were better than flap group, and two-point discrimination：dressing group （6.2 ± 1.0） mm, flap group （7.8 ± 1.1） mm. There were significant differences between the two groups in terms of operative time, hospital stay, treatment costs,two-point discrimination and the range of activities of distal interphalangeal joint and proximal interphalangeal joint （P〈0.01）. Based on the total active motion degrees （TAM） method for evaluation of final follow-up finger function, good rate：dressing group was 93.3%, and flap group was 91.4%. There were no significantly difference between the two groups （P=0.06）. Conclusion In the treatment of fingertip defects, occlusive dressing technique has the advantage of simple, less spending,and good clinical results compared with artery island flaps.It is an ideal method for teating fingertip defects.