背侧皮瓣修复拇指远端软组织损伤的临床疗效

Clinical efficacy of dorsal flap in repairing soft tissue injury of distal thumb

目的分析背侧皮神经营养血管皮瓣与示指背逆行岛状皮瓣修复拇指远端软组织损伤的临床疗效。方法 2016年2月—2017年4月在中国人民解放军联勤保障部队第九六〇医院治疗的拇指远端软组织缺损患者68例,根据患者入院次序分为两组,对照组32例(采用示指背侧逆行岛状皮瓣修复术),观察组36例(采用拇指背侧皮神经营养血管皮瓣修复术)。分析两组患者拇指远端软组织损伤修复的效果。结果治疗6个月后,观察组患者的皮瓣优良率为91. 67%,明显高于对照组的71. 88%(P <0. 05);观察组患者的足端指尖关节(DIP)平均活动度(70°～72°)比例为91. 67%、皮瓣外观满意率94. 44%、无痛率94. 44%、手功能情况满意率97. 22%、皮瓣血运质地优率88. 88%、感觉分级S4 58. 33%、TAM分级优比例为61. 11%,分别高于对照组的71. 87%、78. 12%、84. 37%、84. 37%、68. 75%、37. 50%、40. 62%(均P <0. 05)。结论拇指背侧皮神经营养血管皮瓣修复拇指远端软组织缺损,皮瓣设计较灵活,对患肢、主要血管神经损伤较少,美容效果好,瘢痕较轻,感觉功能修复良好。

Objective To analyze the clinical efficacy of dorsal cutaneous neurovascular flap and retrograde island flap in the repair with soft tissue injury of the distal thumb.Methods From Feb.2016 to Apr.2017,68 patients with distal soft tissue defects treated in the 96th Hospital of the People's Liberation Army Joint Service Support Unit were divided into 2 groups according to the order of admission.Totally 32 patients in the control group were treated with retrograde island flaps.In the observation group,36 patients underwent repair with the dorsal cutaneous neurocutaneous flap of the thumb.The effects of soft tissue injury repair on the distal thumb of the two groups were analyzed.Results After 6 months of treatment,the excellent and good rate of skin flap in the observation group was 91.67%,which was significantly higher than that in the control group(71.88%,P<0.05).The average DIP activity(70°-72°)of the observation group was 91.67%,the flap appearance satisfaction rate was 94.44%,the painless rate was 94.44%,the hand function satisfaction rate was 97.22%,the flap blood transport quality superiority rate was 88.88%,the sensory grade S4 was 58.33%,and TAM grade ratio was 61.11%,which were higher than those of the control group(71.87%,78.12%,84.37%,84.37%,68.75%,37.50%,40.62%,respectively,P<0.05).Conclusion The dorsal cutaneous neurocutaneous flap of the thumb is used to repair the soft tissue defect of the distal thumb.The design of the flap is flexible,the nerve damage to the affected limb and major vascular is less,the cosmetic effect is good,the scar is lighter,and the sensory function is well repaired.