远节手指动脉走行解剖与断指再植

Anatomy of Distal Digits Arteries and Replantation of Severed Digits

目的 了解远节指动脉及分支走行位置及供血区域,探讨末节指再植方法。方法 利用36例病人54个新鲜废弃指的指体动脉内加压灌注墨水染色后在放大镜下解剖和总结临床141例病人189指再植结果。结果 在远侧掌横弓以远动脉血供中,根据动脉走行特点,分为A,B,C三型,其中52指A型血供,即指掌侧固有动脉优势侧在末端动脉血供中占支配地位,主要由优势侧动脉发出3-5条分支,其中指端支最为粗大,其它分支均细小。1指为B型血供,即双侧指掌侧固有动脉发出交通支形成远侧掌横弓后继续向指端走行,形成双指端支,均较粗大。1指为C型血供,双侧指掌侧固有动脉直接吻合成远侧掌横弓后,弓上发出3条分支,均较细小。再植141例189指Ⅰ,Ⅱ区断指,成功率98％。结论 绝大多数指掌侧固有动脉存在着优势动脉现象,优势侧动脉在指端血供中占主要地位,断指再植手术中重点修复优势侧动脉。在远侧掌横弓以远的断指再植术中,修复指端支是恢复远端血供的唯一选择。

Objective Defining the ran way and the supplying region of the arteries and their branches following the end joint finger, exploring the replantation of the end joint finger. Methods The materials are the 54 fresh discarded finger arteries from 36 patients. Bouring ink into them by high pressure for dying, then dissecting them under the magnifying glass. Besides, summarizing the replantation of 189 fingers from 141 clinical patients. Results The pattern of the flood supplying far from the distant arcus palmaris horizontalis, according to the trait of the stretching of arteries, is classified three types, named as A, B, C. Among the samples.there are 52 fingers belonging to A type which means that the superior isde of the artery digitals palmares proproae occupise dominant position in the flood supplying of the terminal artery . Mainly the superior side artery gives off 3 to 5 branches. Among the branches the terminal branch is the most thick, and others are all thin .There is one finger belonging to B type which means that the arteries digitals palmares propriae of two sides gives off the traffic branches to form the distant arcus palmaris horizontals . then goes on stretching to the lip of the finger to form two terminal branches which are all thick. There is one finger belonging to C type which means that the arteries digitals palmares propiae of two two sides directlu tally each other to form the distant areus palmaris horizontalis, then the distant arcus palmaris horizontalis gives off three branches which are all thin. Through replanting all the 189 fingers in Ⅰ and Ⅱ subares from 141 clinical patients, the success rate reaches 98 per cent Conclusion The majority of the artery digitals palmares propriae has the superior artery. and the artery in the superior side occupies the dominant position in the flood supplying of the terminal artery. So the artery inthe superior side should be restored in the replantation of severed digits. In the replantation of severed digits far from the distant arcus palmaris horizontalis, restoring the terminal branch is the single choice of renovating the far flood supplying.