不同灌流方式下动脉化静脉皮瓣用于手部软组织缺损修复的对比研究

Comparative study of different kinds of arterialized venous flap perfusion modes in the treatment of soft tissue defect repairment of hand

目的探讨静脉逆瓣膜动脉化倒置吻合和静脉顺瓣膜动脉化不倒置吻合两种灌流方式用于手部软组织缺损修复的临床效果差异。方法研究对象选取我院2014年4月至2016年4月收治的需行动脉化静脉皮瓣修复手部软组织缺损病人80例,以随机数字表法分为倒置吻合组(40例)和非倒置吻合组(40例),分别采用静脉逆瓣膜动脉化倒置吻合和静脉顺瓣膜动脉化不倒置吻合灌流。比较两组病人的手指功能恢复优良率、皮瓣成活率、术后皮瓣反应分度及治疗满意度。结果倒置吻合组和非倒置吻合组病人的手指功能恢复优良率分别为90.0%、95.0%,差异无统计学意义(χ~2=1.322,P=0.725);倒置吻合组和非倒置吻合组术后皮瓣成活率分别为85.0%,97.5%,非倒置吻合组显著高于倒置吻合组(χ~2=3.914,P=0.048);非倒置吻合组病人术后皮瓣反应分度显著优于倒置吻合组(χ~2=8.143,P=0.025);同时两组病人对于皮瓣外形、手部功能和供区恢复程度的治疗满意度比较,差异均无统计学意义(P均>0.05)。结论静脉顺瓣膜动脉化不倒置吻合灌流用于手部软组织缺损修复可有效提高皮瓣成活率,改善术后皮瓣反应分度,价值优于静脉逆瓣膜动脉化倒置吻合。

Objective To compare the clinical effects of anti?valve arterialized venous flap inverted anastomosis and pro?valve arterialized venous flap non?inverted anastomosis on soft tissue defect repairment of hand.Methods Eighty patients with soft tissue defect of hand in our hospital from April 2014 to April 2016 were collected and randomly divided into two groups:the inverted group(n=40)treated with anti?valve arterialized venous flap inverted anastomosis and the non?inverted group(n=40)receiving pro?valve arterialized venous flap non?inverted anastomosis.The excellent and good rate of hand function recovery,flap survival rate,postoperative skin flap response degree and treatment satisfaction between two groups were compared.Results The excellent and good rate of hand function recovery in inverted group and non?inverted group was 90.0%and 95.0%respectively with the difference being not significant(χ2=1.322,P=0.725).The flap survival rate in inverted group and non?inverted group was 85.0%and 97.5%respectively(χ2=3.914,P=0.048).The postoperative skin flap response degree in non?inverted group was significantly better than in inverted group(χ2=8.143,P=0.025).There was no significant difference in treatment satisfaction between two groups(P>0.05).Conclusion Compared with anti?valve arterialized venous flap inverted anastomosis,pro?valve arterialized venous flap non?inverted anastomosis on soft tissue defect repairment of hand can efficiently increase the survival rate of flap and improve the flap response degree after operation.