| 唐正华,丁法明,陈龙华,徐星星,王巍.带尺骨的尺动脉腕上皮支复合皮瓣移植修复指背复合组织缺损的临床研究[J].浙江中西医结合杂志,2021,31(9): |
| 带尺骨的尺动脉腕上皮支复合皮瓣移植修复指背复合组织缺损的临床研究 |
| Clinical study of composite skin flap with ulnar artery wrist epithelial branch for repairing composite tissue defect of dorsum of finger |
| 投稿时间：2020-09-27 修订日期：2021-06-15 |
| DOI： |
| 中文关键词: 尺动脉腕上皮支 尺骨 皮瓣移植术 指背复合组织缺损 临床效果 |
| 英文关键词:Ulnar artery wrist epithelial branch Ulna Skin flap transplantation Composite tissue Defect of dorsum of finger Clinical effect |
| 基金项目: |
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| 中文摘要: |
| 目的:探讨带尺骨的尺动脉腕上皮支复合皮瓣移植修复指背复合组织缺损的临床效果。
方法:对我院自2014年8月-2019年7月手指外伤导致指背复合组织缺损而收治住院的92例患者进行前瞻性研究。按照治疗方式的不同将患者分为对照组和观察组（各46例）。对照组采用取髂骨植骨+带尺侧屈腕肌腱的尺动脉腕上皮支复合皮瓣移植治疗，观察组采用带尺骨及尺侧屈腕肌腱的尺动脉腕上皮支复合皮瓣移植术进行手术治疗。观察并比较两组患者术后皮瓣受区情况、血清骨源性碱性磷酸酶（BALP）、骨性愈合时间、肌腱总主动活动度优良率等。结果：两组共92例患者，移植后2周、1个月、3个月、6个月、1年均进行随访，皮瓣成活率100%，供区、受区切口均为I期愈合。皮瓣外形、色泽满意，无明显肿胀，皮瓣两点辨别感觉恢复至5-10mm。无明显触痛以及挛缩情况发生。经测定术后观察组患者血清BALP水平明显高于对照组（P<0.05），提示观察组术后钙吸收增强；两组骨性愈合时间比较无明显差异（P>0.05）。经TAM法评定两组患者肌腱总主动活动度，观察组明显高于对照组（χ2=6.574，P=0.010）。结论：带尺骨及尺侧屈腕肌腱的尺动脉腕上皮支上行支皮瓣修复术为解决指背损伤中同时伴有骨、肌腱、软组织缺损的复合损伤提供了很好的解决办法，在此类损伤患者临床治疗上提供更好的选择。 |
| 英文摘要: |
| Objective: To explore the clinical effect of ulnar artery wrist epithelial branch composite skin flap with ulna in repairing composite tissue defect of dorsum of finger. Methods: A prospective analysis was made on the 92 patients with composite tissue defect of the dorsum of fingers caused by finger trauma admitted to our hospital from August 2014 to July 2019. The patients were divided into control group and observation group according to the treatment methods in the data (46 cases in each group). The control group was treated with iliac bone graft and ulnar wrist epithelial branch composite skin flap with ulnar flexor carpal tendon. The observation group was treated with ulnar artery wrist epithelial branch composite skin flap with ulnar and ulnar flexor carpal tendon. Bone alkaline phosphatase, skin flap recipient area, excellent rate of total active tendon activity and femoral healing time were observed and compared between the two groups. Results: Ninety-two patients in both groups were followed up 2 weeks, 1 month, 3 months, 6 months and 1 year after transplantation. The survival rate of skin flaps was 100%. The incisions in donor and recipient areas were healed in stage I. The shape and color of the flaps were satisfactory without obvious swelling. The sensation of two-point discrimination of the flaps was restored to 5-10 mm. No obvious tenderness or contracture occurred. The serum BALP level in the observation group was significantly higher than that in the control group (P<0.05), suggesting that the calcium absorption in the observation group was enhanced after operation; there was no significant difference in bone healing time between the two groups (P>0.05). The total active activity of tendons by TAM method in the observation group was significantly higher than that in the control group (χ2=6.574, P=0.010). Conclusion: Repair of the upper branch of the carpal epithelial branch of ulnar artery with ulnar and ulnar flexor carpal tendon provides a good solution to the complex injury of dorsum of finger accompanied by bone, tendon and soft tissue defects. It provides a better choice for the clinical treatment of patients with such injuries. |
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