指动脉转位与静脉移植修复断指再植中血管缺损

Transposition anastomosis of digital artery versus venous transplantation for repairing arterial defect in replantation of severed finger

[目的]评价指动脉转位与静脉移植修复断指再植中血管缺损的临床效果。[方法]2014年9月~2018年9月对本院153指伴血管缺损的断指进行断指再植术,其中采用指动脉转位技术94指,比较两组围手术期和随访资料。[结果]采用指动脉转位技术94指中,同指动脉转位16指,邻指局部转位29指、邻指顺行转位24指、邻指逆行转位18指、虎口动脉转位7指;缺损长度平均(4.74±1.82)cm。静脉移植组59指,缺损长度平均(4.52±1.41)cm。指动脉转位组中7指出现动脉危象,其中4指再次探查吻合后成活,2指截除,1指部分坏死,总成活率96.81%。静脉移植组12指发生动脉危象,其中5指再次探查后成活,4指截除,3指部分坏死,总成活率88.14%,两组成活率比较差异有统计学意义(P<0.05)。术后12个月,动脉转位组掌指关节、近侧指间关节和远侧指间关节ROM均显著大于静脉移植组,差异均有统计学意义(P<0.05)。术后12个月按BMRC评级标准,动脉转位组再植断指的感觉功能显著优于静脉移植组,差异有统计学意义(P<0.05)。[结论]指动脉转位是修复再植动脉缺损的有效方案,不仅能提高再植指成活率,而且有利于术后神经功能和关节功能恢复。

[Objective]To evaluate the clinical outcomes of digital artery transposition for repairing vascular defects in replantation of severed finger by comparison with venous transplantation.[Methods]From September 2014 to September 2018,153 severed fingers with arterial defects were replanted.Of them,94 fingers were re-vascularized by transposition anastomosis of the digital artery(the TADA group),while 59 fingers had the arterial defect repaired by venous transplantation(the VT group).The perioperative and follow-up documentations were compared between the two groups.[Results]The 94 fingers in the TADA group had arterial defects of(4.74±1.82)cm on average repaired by the same finger artery transposition in16 fingers,adjacent finger local transposition in 29 fingers,adjacent finger anterograde transposition in 24 fingers,adjacent finger retrograde transposition in 18 fingers and artery transposition of the first web space in 7 fingers,whereas the 59 fingers in the VT group received venous transplantation for digital artery defect of(4.52±1.41)cm.After operation,TADA group had artery crisis in 7 fingers,4 of which survived after revised anastomosis and 2 were amputated,1 finger was of partial necrosis with survival rate of 96.81%.In contrast,the VT group had arterial crisis in 12 fingers,5 of which survived after re-exploration,4 fingers were amputated and 2 fingers were of partial necrosis,with overall survival rate of 88.14%.There was a significant difference between the two groups in the survival rate(P<0.05).At 12 months after operation,the TADA groups proved significantly superior to the VT group regarding to range of motions of metacarpophalangeal,proximal interphalangeal and distal interphalangeal joints,as well as the finger sensation recovery(P<0.05).[Conclusion]The transposition anastomosis of digital artery is an effective technique for repairing artery defect in replantation of severed finger,which not only improve the survival rate of replanted finger,but also facilitate the recovery of nerve function and joint function after operation.