踇趾甲床营养血管解剖与临床应用

Nutritional vascular anatomy and clinical application of great toe nail bed

目的研究踇趾甲床营养血管的解剖特点,探讨踇甲瓣修复手指甲床缺损的方法与疗效。方法 2009年7月～2016年3月,选取20例新鲜足部标本,解剖观察踇趾甲床营养血管的分布并进行相关数据的测量。回顾性分析2013年1月～2016年6月安徽省合肥市第二人民医院显微骨科收治的45例手指甲床缺损患者的临床资料,均采用带营养血管的游离踇甲瓣移植修复手指甲床缺损,术后随访,并按中华医学会手外科学会上肢部分功能评定试用标准对患指功能进行评定。结果第1跖背动脉与踇横动脉远侧支吻合形成一动脉弓,动脉弓垂直向踇趾发出3～6分支营养甲床,踇趾腓侧趾底固有动脉向踇趾腓侧远端走行,并向甲床侧缘分3～5分支营养甲床,在趾间关节处数条小静脉相互汇合形成一条趾背静脉。45例临床患者均顺利完成手术,患指甲床缺损踇甲瓣移植后均成活,手部受区伤口均一期愈合,患指功能评定优良率达96%。结论带营养血管的游离踇甲瓣移植修复手指甲床缺损,是修复手指甲床缺损较佳的方法。

Objective To study the anatomical characteristics of the nutrient vessels of the great toe nail bed and explore the method and effect of repairing hand nail bed defects with the great toe nail flap.Methods From July 2009 to March 2016,20 fresh foot specimens were selected to observe the distribution of nutrient vessels in the great toe nail bed and measure the related data.The clinical data of 45 patients with hand nail bed defect admitted by Department of Microscopic Orthopedics,the Second People′s Hospital of Hefei,Anhui Province from January 2013 to June 2016 were retrospectively analyzed.Adopt with the nutrient vessels of the great toe nail bed flap transplantation to repair the hand defected nail bed,postoperative follow-up and according to the Chinese medical association in to upper limb function evaluation trial standard function to assess the wounded finger.Results First dorsal plantar artery and transverse the great toe artery distal anastomosis formed an arch,arch vertical sent the great toe nail bed 3-6 branches nutrition artery.The fibular intrinsic artery of the great toe runs distally and has 3-5 vascular branches to nourish the nail bed.Several small veins join together at the interphalangeal joint to form a dorsal digital vein.A total of 45 cases of clinical patients were successfully completed surgery,the great nail flap survival after transplantation,and the rate of excellence in functional assessment was 96%.Conclusion With nutrient vessels of the great toe nail flap transplantation to repair nail bed defect treatment,it is a better method to repair hand nail bed.