章伟文 陈宏 王晓峰 周黎明 李学渊 薛建波 费建荣 315040 浙江， 宁波市曙光手外科医院 中华手外科杂志 1999 0 15 2


    关键词：再植术；指；临床研究；显微外科手术 期刊 zhswkzz 0 论著 fur -->


    

【摘要】 目的 对末节断指进行临床研究和分型,提高再植成活率。 方法 再植末节断指530 例645指。 在手术显微镜下观察36指毁损指末节的血管、神经分布。 结果 末节断指分成三型。 Ⅰ型:离断部位自远节指间关节横纹至甲根部,共434指;Ⅱ型:甲根部至指腹螺纹中心(包括斜面离断),共137指;Ⅲ型:指腹螺纹中心以远,共74指。 Ⅰ、Ⅱ型的动脉口径为0.3 mm ～ 0.6 mm,指背和指腹侧静脉口径为0.3 mm ～ 0.8 mm。 Ⅲ型的指动脉呈分支状,口径0.1 mm ～ 0.3 mm,静脉口径0.15 mm ～ 0.3 mm。 三型再植成活率分别为97.7 %、95 %和97 %，再植指感觉恢复良好，外形满意。 结论 Ⅰ、Ⅱ型末节断指需在10倍手术显微镜下吻合血管，Ⅲ型应在放大16倍镜下吻合血管。

Replantation of severed distal segment of fingers:a report of 530 cases

ZHANG Weiwen, CHEN Hong, WANG Xiaofeng, et al. Department of Hand Surgery, Ningbo Shuguang Hand Surgery Hospital, Zhejiang 315040

【Abstract】 Objective To study and classify the severed distal segment of fingers and increase the survival rate of replantation. Methods 645 severed distal segments of fingers in 530 cases were studied. The distribution of blood vessels and nerves in the distal segment were observed under microscope using 36 mutilated fingers. Results Severance of the distal segments could be classified into 3 types according to the level of amputation: type Ⅰ, between the distal interphalangeal joint and nail root; type Ⅱ, between the nail root and the center of swirling fingerprint; and typeⅢ, distal to the center of swirling fingerprint. 434 fingers of this series were categorized as typeⅠ. And there were 137 and 74 fingers classified into type Ⅱ and type Ⅲ respectively. In typeⅠ and Ⅱ, the diameter of the arteries was around 0.3 to 0.6 mm, and that of the veins was 0.3 to 0.8 mm. In type Ⅲ , the artery was ramified, with diameter of 0.1 to 0.3 mm. Thediameter of the veins was 0.15 to 0.3 mm. The survival rate after replantation was 97.7 %,95 %, and 97 % respectively. The replanted fingers had satisfactory sensation andappearance. Conclusions The severed distal segment of fingers in typeⅠand type Ⅱ should be replanted under 10 × magnification. The vessels of the fingers in type Ⅲ should be anastomoses under 16 × magnification.

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