中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2017, Vol. 12 ›› Issue (11): 1911-1917.doi: 10.4103/1673-5374.219053

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

指尖I区截断再植后感觉功能的评估与恢复

  

  • 收稿日期:2017-09-15 出版日期:2017-11-15 发布日期:2017-11-15
  • 基金资助:

    广东省卫生厅基金项目（A2016018），高等教育博士专项基金（20120171120075），广东省科技项目（2014A020212479），广州市科技项目（201300000174），广东省科技项目（2016A010103012），广东省自然科学博士启动项目（2017A030310302）

Evaluation of sensory function and recovery after replantation of fingertips at Zone I in children

Zhao-wei Zhu1, 2, Xiao-yan Zou3, Yong-jun Huang4, Jiang-hui Liu5, Xi-jun Huang2, Bo He2, Zeng-tao Wang6   

  1. 1 Department of Plastic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
    2 Department of Orthopedics and Microsurgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
    3 Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
    4 Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong Province, China
    5 Department of Emergency, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
    6 Department of Hand and Foot Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
  • Received:2017-09-15 Online:2017-11-15 Published:2017-11-15
  • Contact: Bo He, M.D., Ph.D.,hebodoc@gmail.com or hebodoc@aliyun.com.
  • Supported by:

    This study was supported by a grant from the Department of Health of Guangdong Province of China, No. A2016018; the Specialized Research Fund for the Doctoral Program of Higher Education, No. 20120171120075; a grant from the Science and Technology Project of Guangdong Province of China, No. 2014A020212479; a grant from the Science and Technology Program of Guangzhou City of China, No.201300000174; a grant from the Science and Technology Project of Guangdong Province of China, No. 2016A010103012; a grant from the Doctoral Start-up Project of the Natural Science Foundation of Guangdong Province of China, No. 2017A030310302.

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摘要：

感觉功能是断指再植后重要的评价标准。但目前的临床研究主要关注断指再植的手术方法和适应证，少有研究关注再植后手指感觉功能的恢复。文章回顾性分析了2014年7月至2016年1月在中山大学第一附属医院进行的8例(9个指尖)I区断指再植，因为损伤缺损的程度不一，导致有些断指残存的血管或神经过短，甚至缺失，无法实现无张力缝合修复，所以9个指尖中4个行动静脉吻合修复，另5例在断指再植过程中仅进行动脉吻合，其中3例同时行神经修复，另6例在断指再植过程中未进行神经修复。结果中所有8例患者指尖均成功重建。相比于不进行血管吻合的患者，经血管吻合患者再植指尖没有出现明显的萎缩现象，且感觉功能均成功恢复。结果说明当动脉和静脉成功吻合后，无论是否修复神经，重建的指尖均具有良好的感觉功能和美学效果。

orcid:0000-0002-9690-4527(Bo He)

 

关键词: 神经再生, 指尖再植, 神经功能, 显微外科, 手外科, 解剖学, 整形医学, 血管

Abstract:

Sensory function is the most significant criterion when evaluating the prognosis of replanted fingers. Current clinical research has focused
on surgical techniques and indications for finger replantation; however, few studies have focused on recovery of finger sensory function after replantation. This study retrospectively assessed data of eight patients who had undergone nine Zone I replantations of the fingertips in the First Affiliated Hospital of Sun Yat-sen University of China from July 2014 to January 2016. Variations in the extent of damage, with the residual vessels or nerves in some fingers being too short or even missing, prevented tension-free suture repair in some patients. Thus, repair of four of the nine fingertips included arteriovenous anastomosis, the remaining five undergoing arterial anastomosis during replantation of the amputated fingers. Three patients underwent nerve repair, whereas the remaining six cases did not. Fingertip replantations were successful in all eight patients. Compared with the patients without vascular anastomosis, no obvious atrophy was visible in the fingertips of patients who did undergo vascular anastomosis during replantation and their sensory function did recover. Fingertip replantation provides good sensory function and cosmetic outcomes when good artery and vein anastomoses have been created, even when digital nerves have not been repaired.

Key words: nerve regeneration, fingertip replantation, neurological function, microsurgery, hand surgery, anatomy, plastic surgery, blood vessels, neural regeneration