改良静脉移植处理动脉顽固性痉挛的拇指再植

Modified venous grafting to replant an amputated thumb with obstinate arteriospasm

目的探讨动脉顽固性痉挛时采用静脉移植桥接指固有动脉与桡动脉进行改良再植离断拇指的疗效。方法回顾性分析2011年6月至2017年5月唐山市第二医院手二科治疗的9例(9指)离断拇指再植时发生双侧指固有动脉顽固性痉挛且不能缓解的患者资料。患者均为男性;年龄21~55岁,平均39.2岁。右拇指2例2指,左拇指7例7指。采用改良前臂浅静脉游离移植端端或端侧吻合桥接拇指尺侧指固有动脉与鼻烟窝处桡动脉供血。末次随访时根据中华医学会手外科学会断指再植功能评定试用标准评定结果。结果9例患者9指顺利成活,伤口一期愈合,术后获6~12个月(平均7.9个月)随访。2例旋转撕脱伤指体轻度萎缩,患者均对指体外观及功能表示满意。末次随访时根据中华医学会手外科学会断指再植功能评定试用标准评定结果:优7指,良2指;指腹两点辨别觉3~8 mm,平均5.3 mm。结论采用游离静脉桥接拇指尺侧指固有动脉与鼻烟窝处桡动脉,建立动脉供血,再植动脉顽固性痉挛的拇指,手术操作简单,血供可靠,可获得满意的效果,值得临床推广应用。

Objective To evaluate the therapeutic effects of bridging the proper digital artery and the radial artery with a vein graft in replantation of an amputated thumb with obstinate arteriospasm.Methods From June 2011 to May 2017,9 patients received replantation of an amputated thumb at Department of Hand Surgery,The Second Hospital of Tangshan.They were all male,aged from 21 to 55 years(average,39.2 years).Two right thumbs were involved in 2 cases and 7 left thumbs in 7 cases.During replantation,obstinate arteriospasm which could not be alleviated occurred of their bilateral proper digital arteries.A free forearm superficial vein graft was used to bridge the distal end of ulnar proper digital artery of thumb and the radial artery in tabatiere anatomique to establish blood supply by end-to-end or end-to-side anastomosis.At final follow-up,the outcomes were assessed by the tentative criteria set by The Hand Surgery Society of Chinese Medical Association.Results All the 9 replanted thumbs survived with primary wound healing.They were followed up for 6 to 12 months(mean,7.9 months).All the patients were satisfied with the appearance and function of the replanted thumb except that mild atrophy was observed in 2 digits with preoperative rotatory avulsion.According to the tentative criteria set by The Hand Surgery Society of Chinese Medical Association at final follow-up,the outcomes were rated as excellent in 7 cases and as good in 2.The pulp two-point discrimination was between 3 and 8 mm,with an average of 5.3 mm.Conclusions An amputated thumb with obstinate arteriospasm can be replanted by bridging the ulnar proper digital artery of thumb and the deep branch of radial artery using a vein graft to establish adequate blood supply to the replanted thumb,leading to satisfactory efficacy.As the technique is easy,it is worthy of popularization.