闭合性指动脉损伤诊断及治疗.docVIP

闭合性指动脉损伤诊断及治疗 　【摘要】 目的 探讨闭合性指动脉损伤采用血管移植修复的可行性。方法 通过对2003年6月至2008年5月28例闭合性指动脉损伤病例采用血管移植修复受损的指动脉，总结闭合性指动脉损伤的诊断与治疗。结果 本组28例手术后成活27例,成活率96.4%。平均随访12个月，采用国际手外科联合会Nako-mura tamal评价标准，优18例，良8例，中1例，失败1例，优良率为92.8%。结论 确诊为闭合性指动脉损伤者，应积极治疗，尽早手术探查，采用血管移植修复损伤的指动脉。对损伤段血管的判断、术中血管移植，以及术后护理十分重要。 【关键词】 闭合性损伤 指动脉损伤 血管移植 诊断 治疗 【Abstract】 Objective To explore the feasibility of repairing the closed injured arteries by vascular grafting. Methods Retrospective study was performed to the 28 cases of closed injury of digital arteries that were repaired by vascular grafting from June 2003 to May 2008. Result 27 of the 28 cases survived, and the survival rate was 96.4%. 28 cases were followed up, the average time was 12 months. The evaluation of the results was based on the Nako-mura tamal standard set by International Federational of Societies for Surgery of the Hand (IFSSH). And the result was excellent in 18 cases, good in 8, eligible in 1, fail in 1. The excellent rate was 92.8%. Conclusion Patients who were diagnosed as the closed injury of digital arteries should be treated actively, surgical exploration should be performed and the injured arteries should be repaired by vascular grafting as soon as possible. The judge of the segment of injured vessles, the vascular grafting during the operation, and the postoperative care are of greatimportance. 【Key words】 Closed injury Digital artery injury Vasotransplantation Diagnosis Treatment 闭合性指动脉损伤在临床上并不少见,但常会造成漏诊，且如果处理不当往往会造成手指的坏死［１］。本科2003年6月至2008年4月共治疗闭合性指动脉损伤患者28例，通过术前的体格检查和急诊彩色超声多普勒诊断，采用显微外科方法切开探查,利用前臂浅静脉移植修复指动脉,效果满意。现报告如下。 1 临床资料 1.1 一般资料 本组28例,男19例,女9例,年龄8～47岁（平均28.3岁）；木棍砸伤8例,重物压伤7例,绳索钢丝勒伤5例,冲床撞击伤6例，拳击伤2例。其中拇指2例,示指12例,中指7例,环指5例,小指2例；合并伤伴骨折9例,伴指神经断裂3例；25例有不同程度指神经挫伤（伤指皮肤均完整）。28例中，17例修复双侧指动脉,11例修复优势侧指动脉,均采用前臂浅静脉移植。 1.2 诊断依据 指动脉闭合损伤的诊断通过体格检查一般能得出结果,主要表现有：（1）损伤远端指腹两侧指动脉走行路线出现线行瘀斑;（2）损伤以远的手指皮温低,毛细血管反流缓慢。通过超声多普勒可诊断血管的栓塞和血流中断［１］。 1.3 治疗方法 手术在臂丛麻醉下进行,术中应用气压止血带,合并骨折者先进行骨折内固定。在指腹瘀斑明显处作侧方Z字切口,暴露指动脉及神经,即可发现损伤的指动脉,并可见形成的血栓,术中剪除损伤段血管至正常部位。此时，由于血管有