指侧方静脉动脉化再植手术在末节断指患者中的应用观察

Application Observation of Arterialized Replantation of Lateral Digital Vein in Patients with Distal Amputation

目的:分析指侧方静脉动脉化再植手术在末节断指患者中的应用效果。方法:回顾性选取2017年5月—2019年11月中国人民解放军联勤保障部队第九八八医院收治的85例末节断指患者作为研究对象,研究组43例予以指侧方静脉动脉化再植手术治疗,对照组42例予以指腹静脉动脉化再植手术治疗,比较两组患者再植指成活率、关节活动度优良率、预后情况(远侧指间关节活动度、指甲长度、两点分辨觉、感觉恢复)、围手术期血清总抗氧化能力(T-AOC)、过氧化氢酶(CAT)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)。结果:研究组再植指成活率100.00%高于对照组78.57%,差异有统计学意义(χ^(2)=6.224,P<0.05)。研究组再植指关节活动度优良率90.70%高于对照组69.05%,差异有统计学意义(χ^(2)=10.306,P<0.05)。研究组再植指远侧指间关节活动度、指甲长度、两点分辨觉、感觉恢复情况均优于对照组,差异有统计学意义(t=12.347,4.884,11.883,9.546,P<0.05)。研究组术后12 h、术后24 h T-AOC、CAT、SOD、GSH-Px高于对照组,MDA低于对照组,差异有统计学意义(F=49.827、93.480、138.846、55.614、64.256,P<0.05)。结论:指侧方静脉动脉化再植手术应用于末节断指患者,再植指全部成活,且术后关节活动度恢复较佳,氧化应激反应较轻,可明显改善各项预后指标,是安全可行的断指再植术式。

Objective:To analyze the effect of arterial replantation of lateral digital vein in patients with distal amputation.Methods:A total of 85 patients with amputated fingers in the distal segment of our hospital from May 2017 to November 2019 were retrospectively selected.Forty-three patients in the study group were treated with arterialized replantation of the lateral finger vein,and 42 patients in the control group were treated with arterialized replantation of the abdominal vein.The survival rate of re⁃planted fingers,excellent and good rate of joint range of motion,prognosis(range of motion of distal interphalangeal joint,nail length,two-point discrimination,sensory recovery),and total perioperative serum antioxidant capacity(T-AOC),catalase(CAT),su⁃peroxide dismutase(SOD),glutathione peroxidase(GSH-Px)and malondialdehyde(MDA)were compared between the two groups.Results:The survival rate of finger replantation in the study group was 100.00%,which was higher than 78.57%in the control group,and the difference was statistically significant(χ^(2)=6.224,P<0.05).The excellent and good rate of motion of the replanted finger joints in the study group was 90.70%,which was higher than 69.05%in the control group,and the difference was statistical⁃ly significant(χ^(2)=10.306,P<0.05).The replanted finger distal interphalangeal joint range of motion,nail length,two-point discrim⁃ination,and sensory recovery in the study group were better than those in the control group,and the differences were statistically significant(t=12.347,4.884,11.883,9.546,P<0.05).T-AOC,CAT,SOD,GSH-Px in the study group were higher than those in the control group at 12 h and 24 h after operation,and MDA was lower than that in the control group,with statistically significant differences(F=49.827,93.480,138.846,55.614,64.256,P<0.05).Conclusion:The arterialization of the lateral vein of the fin⁃ger is applied to the patients with amputated distal fingers.All the replanted fingers survived,and the postoperative joint mobility recovered well,and the oxidative stress reaction was mild.It can significantly improve various prognostic indicators,and is a safe and feasible method for replantation of severed fingers.