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改良
血管
套接
断指
再植
患者
成活
微循环
影响
詹克椿
-128-Chinese and Foreign Medical Research Vol.21,No.3 January,2023经验体会 Jingyantihui中外医学研究第 21 卷 第 3 期(总第 551 期)2023 年 1月中医,2021,43(6):1000-1003.15 张鹏飞,王文德.针刀联合手法治疗颈源性头痛的临床研究 J.针灸临床杂志,2018,34(4):15-18.16 赵利涛,吕海文.颈 2 背根神经节脉冲射频联合连续硬膜外阻滞治疗颈源性头痛的效果分析 J.颈腰痛杂志,2019,40(3):386-388.17 王军威,欧国峰,袁普卫,等.内热针治疗中晚期强直性脊柱炎的疗效观察 J.北京中医药大学学报,2020,43(3):242-247.18 刘振鹏,刘娜,宫小文,等.颈 2 背根神经节脉冲射频联合硬膜外阻滞治疗难治性颈源性头痛 J.中国疼痛医学杂志,2018,24(7):557-558,560.19 张广建,李华,李美睿,等.颈 2 背根节脉冲射频联合硬膜外持续镇痛治疗颈源性头痛 J.中国疼痛医学杂志,2018,24(9):694-696.(收稿日期:2022-08-08)(本文编辑:程旭然)福州海福手外科医院福建福州350000改良血管套接法对断指再植患者断指成活和微循环的影响詹克椿【摘要】目的:探讨断指再植患者应用改良血管套接法对断指成活和微循环的影响。方法:回顾性分析 2020 年 1 月 2022 年 1 月福州海福手外科医院收治的 80 例手指离断伤患者的资料,根据不同手术方式分为观察组(n=37,在断指再植术中选择改良血管套接法作为手术方案)和对照组(n=43,在断指再植术中选择血管端端吻合术作为手术方案)。比较术后 1、3、5 d 两组再植指微循环血运情况 再植指的毛细血管充盈时间(CRT)、再植指微循环测量值、经皮氧分压(TcPO2)、经皮血氧饱和度(SpO2),比较术后 7 d 两组的再植指成活情况(再植指成活率、再植指颜色正常率与再植指张力正常率)。结果:术后 1、3、5 d,两组 CRT、再植指微循环测量值逐渐下降,且观察组的 CRT 短于对照组,再植指微循环测量值明显低于对照组(P0.05),两组的 TcPO2、SpO2水平逐渐提高,且观察组的 TcPO2、SpO2水平均高于对照组(P0.05)。观察组术后 7 d 再植指成活率、颜色正常率及张力正常率均高于对照组(P0.05)。结论:在断指再植术中应用改良血管套接法可以更好地减少患指 CRT,改善再植指微循环情况,提升再植指 TcPO2与 SpO2,从而促进肢体功能尽快恢复。【关键词】断指再植术改良血管套接法断指成活微循环doi:10.14033/ki.cfmr.2023.03.032 文献标识码B 文章编号1674-6805(2023)03-0128-04Effect of Modified Vascular Cuff Grafting on the Survival and Microcirculation of Severed Fingers in Patients with Replantation of Severed Fingers/ZHAN Kechun./Chinese and Foreign Medical Research,2023,21(3):128-131AbstractObjective:To investigate the effect of modified vascular cuff grafting on the survival and microcirculation of severed fingers in patients with replantation of severed fingers.Method:The data of 80 patients with severed fingers admitted to Fuzhou Haifu Hand Surgery Hospital from January 2020 to January 2022 were analyzed retrospectively.According to different surgical methods,they were divided into the observation group(n=37,the modified vascular cuff grafting method was selected as the surgical scheme in the replantation of severed fingers)and the control group(n=43,the vascular end-to-end anastomosis was selected as the surgical scheme in the replantation of severed fingers).The microcirculation blood supply of replanted fingers capillary refill time(CRT)of replanted fingers,microcirculation of replanted fingers,transcutaneous oxygen pressure(TcPO2)and transcutaneous oxygen saturation(SpO2)were compared between the two groups at 1,3,5 d after operation.And the survival condition of replanted fingers(survival rate of replanted fingers,normal color rate of replanted fingers and normal tension rate of replanted fingers)were compared between the two groups at 7 d after operation.Result:At 1,3,5 d after operation,the CRT and measured values of microcirculation of replanted fingers in the two groups decreased gradually,and the CRT in the observation group was shorter than that in the control group,and the measured values of microcirculation of replanted fingers were significantly lower than those in the control group(P0.05);the levels of TcPO2 and SpO2 in the two groups were gradually increased,and the levels in the observation group were higher than those in the control group(P0.05).Seven days after operation,the survival rate,normal color rate and normal tension rate of replanted fingers in the observation group were higher than those in the control group(P0.05);两组断指部位及创伤原因情况比较差异无统计学意义(P0.05),有可比性,见表 1。本研究经医院医学伦理委员会批准;患者或家属均知情同意。表1两组断指部位及创伤原因比较指(%)组别断指部位拇指食指中指无名指小指观察组(n=46)14(30.43)15(32.61)10(21.74)5(10.87)2(4.35)对照组(n=50)16(32.00)15(30.00)11(22.00)6(12.00)2(4.00)2值0.105P 值0.999表1(续)组别创伤原因撕脱伤切割伤机械性砸伤电锯伤爆炸伤观察组(n=46)11(23.91)12(26.09)5(10.87)15(32.61)3(6.52)对照组(n=50)12(24.00)13(26.00)7(14.00)14(28.00)4(8.00)2值0.428P 值0.989reduce CRT of affected fingers,improve the microcirculation of the replanted fingers,and improve the TcPO2 and SpO2 of the replanted fingers,so as to promote the recovery of limb function as soon as possible.Key wordsReplantation of severed fingersModified vascular cuff grafting methodSevered fingers survivalMicrocirculationFirst-authors address:Fuzhou Haifu Hand Surgery Hospital,Fuzhou 350000,China1.2方法两组均行断指再植术:(1)进行臂丛神经阻滞麻醉后,先用肥皂水或清水清洗伤指断端,再用0.1%氯己定(西安天正药用辅料有限公司)浸泡断端10 min,用 2.5%碘伏(山东福尔特消毒制品有限公司)消毒。(2)于显微镜指导下,对断端失活及被污染组织进行彻底清创处理,适当处理血管吻合口周围脂肪组织,以避免吻合口受压过度和软组织肿胀。清创后以 300 mL 右旋糖酐 40 葡萄糖注射液(江苏淮安双鹤药业有限责任公司,国药准字H32022427,规格:500 mL50 g)静脉滴注抗凝。(3)去除患指吻合口周围的血管外膜,应用 Z 形缝合,再植顺序依次为骨骼-肌腱-指背静脉(多位于手指背侧的筋膜层内)-背侧皮肤-指动脉(位于指屈肌腱外上方筋膜脂肪组织中)-指神经-掌侧皮肤,操作过程中不可缝合肌腱。-130-Chinese and Foreign Medical Research Vol.21,No.3 January,2023经验体会 Jingyantihui中外医学研究第 21 卷 第 3 期(总第 551 期)2023 年 1月其中血管吻合操作时,(1)观察组进行改良血管套接法,操作如下:将血管吻合口充分暴露后,修剪套入端的血管外膜,用显微镊扩张套端血管(动脉-近端,静脉-远端),并纵行剪开其上侧至相当或略长于血管外径的长度。血管缝合,依次为第 1 针(全层缝合套端剪口顶部及其对应端)、第 2 针(于第 1 针对侧,缝合与套端重叠处的套入端外膜和部分中膜)及第 3、4 针(分别将所剪开的相对应游离的血管壁与套入端缝合,其中全层缝合套端,缝合套入端外膜及中层)。(2)对照组进行血管端端吻合法(二定点间断缝合法),操作如下:将两端血管夹移进,使血管对端靠近,在上、下各做一定点缝合,每针均自血管内向外穿出,两针同时在血管外侧结扎,然后在二定点线中间再缝一针,最后观察血管口径的大小进行适当加针。缝合时保持相同边距,一般为血管壁厚度的 12 倍,针距一般为边距的 12 倍。两组术后行抗凝及抗血管痉挛治疗。1.3观察指标及评价标准分别于术后 1、3、5 d,比较两组的再植指微循环血运情况,包括毛细