牵拉性撕脱伤对动脉闭塞率影响.doc

牵拉性撕脱伤对动脉闭塞率影响(1.第四军医大学西京医院整形外科中心　西安710032　2.近畿大学医学部形成外科,日本大阪) 潘宝华,1963年生,1987年第四军医大学医疗系毕业,现任第四军医大学西京医院整形外科中心主治医师,医学博士,发表论文7篇,参编整形美容专著3部。[摘　要]　目的:研究在牵拉性撕脱损伤时动脉内膜的变化及其闭塞率。　方法:建立大白鼠动脉牵拉性撕脱伤模型,给予60～140g牵拉力,观察其内膜形态变化。　结果:随牵拉力的增加,闭塞率逐渐增大,至140g时达到100%。形态观察可分为:①内膜断裂型;②内膜瓣状型二个类型。牵拉损伤的动脉切断后原位显微吻合的成功率为83.33%。　结论:损伤动脉有特征性的内膜变化,瓣状型内膜损伤可导致血栓形成,影响显微外科的成功率。 [关键词]　牵拉性撕脱伤　动脉　内膜　闭塞率 [中图分类号]R616.2　[文献标识码]A　[文章编号]1008-6455(2000)05-0328-04 THE EFFECT OF DISTRACTION AVULSION INJURY ON ARTERIAL OCCLUSION RATE PAN Bao-Hua　LI Hui-Yuan　LU Kai-Hua et al Depatment of Plastic Surgery,Xijing Hospital,The Fourth Military Medical University,Xi?an,710032 [Abstract]　Objective:To investigate the morphological changes and occlusion rate of post-avulsion injury artery.　Methods:Rat model for arterial avulsion injury was developed.Distraction force of 60-140g was applied separately.The morphological changes of arterial endometrium were observed.　Result:With the increasing of distraction forec,the occlusion rate was increased accordingly.When the distraction force increased up to 140g,the occlusion rate was 100%.The morphological changes could be divided into 2 main types:1.Endometrium rupture and 2.Endometrium valve formation.The injured artery was divided and anastomosed in situ,the patency rate was 83.33%.　Conclusion:〖WT5”BZ〗There were typical endometrium changes after artery injury.Endometium valve formation leaded to thrombosis and further compromised the success of microsurgery. [Key words]　Distraction avulsion injury　Artery　Endometrium　Occlusion rate 1877年俄国Eck创立了血管吻合术[1],成为血管修复史的一个里程碑。血管吻合方法[2]、手术器材的更新及其抗凝剂、血管扩张剂、抗生素的出现和应用,使血管吻合后的栓塞率大幅下降[3,4]许多有严重损伤的病例救治成功,也为美容医学尤其是美容外科的发展提供了又一途径。但比起其它的损伤因素所致的断指来说,有牵拉性撕脱损伤的病例其再植成功率相对要低[5]。动脉血栓的发生率,在牵拉损伤时明显高于其它损伤机制[6]。有撕脱伤的皮瓣,发生坏死的可能性也高于其它的损伤。?我们利用血管损伤模型,探讨牵拉性撕脱损伤对动脉内膜的影响及其血管栓塞率的关系,为显微外科、整形美容外科临床提供理论依据。 1　材料与方法?实验动物及分组,8周龄的Wistar/ST大白鼠(日本SLC株式会社),体重280～310g,普通喂养。10mL?L?-1α-氯醛糖加100mLL?-1氨基甲酸乙制酯(日本和光纯药)腹腔内注射麻醉动物,沿双侧腹股沟韧带切开皮肤约3cm,