示指桡侧指固有动脉转位在拇指近节基底旋转撕脱离断再植中的应用

The application of radial proper digital artery of index finger transposition in replantation of rotational avulsed amputation of proximal phalanx basal of thumb

目的介绍应用示指桡侧指固有动脉转位在拇指近节基底撕脱离断再植中的手术方法和临床效果。方法自2019年8月至2020年10月我们共收治拇指近节基底撕脱离断8例,其中完全离断7例,不完全离断1例,离断拇指双侧指固有动脉均自近端抽出。完全离断拇指一期选择示指桡侧指固有动脉转位重建拇指血运;不完全离断拇指一期选择静脉游离移植桡动脉转位重建拇指血运,术后18 h出现动脉危象,行血管探查,示指桡侧指固有动脉转位重建拇指血运。结果术后再植拇指全部存活,伤口Ⅰ期愈合,术后6~8周指骨骨折愈合,拔除克氏针。术后随访时间为6~9个月,平均8个月。再植拇指指腹饱满,指体无明显萎缩,外展及对掌活动自如。指端感觉恢复至S51例,S4+4例,S3+3例。根据中华医学会手外科学会上肢部分功能评定试用标准评定:优5例,良2例,可1例。示指功能正常。结论示指桡侧指固有动脉解剖恒定,重建离断拇指血运疗效肯定,且术中体位舒适,操作方便。

Objective To introduce the surgical method and clinical efficacy of radial proper digital artery of index finger transposition in replantation of rotational avulsed amputation of proximal phalanx basal of thumb.Methods From August 2019 to October 2020,8 cases of rotational avulsed amputation of proximal phalanx basal of thumb were treated in our department,including 7 cases of complete amputation and 1 case of incomplete amputation.The proper digital arteries on both sides of the severed thumb were extracted from the proximal end.The radial proper digital artery of index finger was transposed to reconstruct the blood supply of the thumb with complete amputation.The free vein transplantation and radial artery transposition was selected to reconstruct the blood supply of the thumb with incomplete amputation,and the arterial crisis occurred 18 hours after operation.The vascular exploration was performed to reconstruct thumb blood supply by transposition of radial proper digital artery of index finger.Results All the 8 cases survived with primary wound healing.All the digital fractures healed and Kirschner wires were removed 6 to 8 weeks after operation.The follow-up time was 6 to 9 months,with an average of 8 months.The pulp of the replanted thumb is full,the finger body has no obvious atrophy,and the abduction and opposition movement recovered.The fingertip sensation recovered to S5 in 1 case,S4+in 4 cases and S3+in 3 cases.According to the trial standard of upper limb function evaluation issued by Hand Surgery Society of Chinese Medical Association,5 cases were excellent,2 cases were good and 1 case was fair.The index finger function is normal.Conclusion The anatomy of radial proper digital artery of index finger is constant,the effect of revascularization of the severed thumb is positive,and the intraoperative position is comfortable and easy to operate.