一种精分5型诊断技术在指端损伤精准修复中的应用:38例报告

Application of a 5-type precise diagnostic technique in the precise repair of digit-tip injuries: 38 cases report

目的:探讨一种精分5型诊断技术在一体化手指指端损伤精准修复与重建方式中的应用价值。方法:2012年3月-2022年6月,合肥市第二人民医院骨科共收治手指指端损伤38例45指,患者平均年龄33岁,其中拇指15指,示指9指,中指16指,环指4指,小指1指。在显微镜视下按离断小组织块内有效血管情况精分5型诊断:Ⅰ型指掌侧固有动脉型(10指)、Ⅱ型细小动脉型(5指)、Ⅲ型全静脉型(4指)、Ⅳ型掌浅弓型(4指)及Ⅴ型血管缺失型(22指)。根据精分5型诊断选择手术时机及方法:①Ⅰ~Ⅳ型16例(23指),急诊分型、小组织块原位再植。其中Ⅰ~Ⅱ型常规再植;Ⅲ型静脉动脉化再植;Ⅳ型动、静脉转流再植。②Ⅴ型22例(22指),分期分类足趾小组织瓣移植修复。移植修复手术时机:急诊手术7例,亚急诊手术12例,择期手术3例;优选足趾小组织瓣类型:甲瓣9例,重建末节指骨的甲瓣3例,趾腓侧皮瓣5例,趾腹皮瓣3例,第2趾末节甲床复合组织瓣2例。45个再植(或移植)的小组织块(或组织瓣)的大小1.0 cm×0.6 cm×0.4 cm~2.2 cm×1.5 cm×0.8 cm。供区直接拉拢缝合。术后应用医疗APP延伸指导手指功能锻炼,通过门诊和医疗APP定期随访,评估临床疗效。结果:45指再植和(或)移植术后的小组织块(或组织瓣)均成活,并获得6个月~7年随访,平均36个月,伤指指端外观接近正常,两点辨别觉(TPD)为3~7 mm。按《密歇根大学手概况问卷调查表》(MHQ)进行评价,结果优32例(37指),良5例(7指),差1例(1指),优良率97.78%。结论:精分5型诊断技术是手指指端损伤一体化精准修复与重建方式的关键,该方式经临床验证,伤指可获得逼真外形恢复的疗效。

Objective To explore an applicative value of a 5-type precise diagnostic technique in integrated precise repair and reconstruction of digit-tip injuries.Methods From March 2012 to June 2022,45 digit-tip injuries(38 patients,with an average age of 33 years old)were classified under microscope on the basis of effectiveness of blood vessels remained in the severed tissue.Among the injured digits,there were 15 thumbs,9 index fingers,16 middle fingers,4 ring fingers and 1 little finger.The diagnosis was categorised into 5 types according to involvement of blood vessels:Type I,injury of proper palmar digital artery(10 digits);Type II,injury of small artery(5 digits);TypeⅢ,injury of whole vein(4 digits);Type IV,injury of superficial palmar arch(4 digits);and Type V,vessels missing(22 digits).The timing and therapeutic method of surgery were selected based on the precise classification of 5 types of diagnosis:(1)For typeⅠ-Ⅳinjuries,16 patients(23 digits)received in situ tissue replantation after emergency classification.Of which,typeⅠ-Ⅱinjuries received conventional replantation,typeⅢinjuries had replantation with arterialised vein,and type IV injuries received replantation with artery-vein shunt.(2)For the type V injuries,22 patients(22 digits),staged and categorised flap reconstruction with toe flaps were performed.Of which,7 were performed in emergency surgery,12 in subemergency surgery and 3 in elective surgery.Based on the severity of defects,small tissue flaps of toe were used in reconstruction of type V injuries and following toe flaps were employed:9 hallux nail flaps,3 hallux nail flaps(for reconstruction of distal phalanx),5 hallux fibular flaps,3 hallux abdominal flaps and 2 compound tissue flaps with nail bed of the second toe.The sizes of the 45 replanted/transferred tissues flaps were 1.0 cm×0.6 cm×0.4 cm-2.2 cm×1.5 cm×0.8 cm.Donor sites directly sutured.Medical APP was applied in the rehabilitation exercises.Functions of digits were assessed by scheduled follow-ups at outpatient clinic and via remote medical APP to evaluate the clinical efficacy.Results All small tissue blocks and(or)tissue flaps survived after replantation and(or)flap reconstruction of 45 injured digits.Postoperative follow-up lasted for 6 months to 7 years,with 36 months in average.The appearances of the reconstructed digit-tips were close to normal digits,with TPD at 3-7 mm.According to the Michigan Hand Outcomes Questionnaire(MHQ),32 patients(37 digits)were in excellent,5 patients(7 digits)in good,and 1 patient(1 digit)in poor,with 97.78%of excellent and good rate.Conclusion Five-type precise diagnostic technique is the key to the integrated and precise reconstruction of digit-tip injuries.This method has been clinically validated and achieved realistic recovery from the injured digits.