改良骨间背侧动脉穿支游离皮瓣修复手部掌侧软组织缺损的效果(1)
[摘要]目的 研究改良骨间背侧动脉穿支游离皮瓣修复手部掌侧软组织缺损的临床效果和对患者术后感觉功能和外观形态的影响。方法 将我院2017年1～12月收治的30例手部掌侧软组织缺损患者作为研究对象，采用系统随机化法分为改良组(n=15)和常规组(n=15)，其中改良组行改良骨间背侧动脉穿支游离皮瓣修复术，常规组采用骨间背侧动脉游离皮瓣修复术治疗，比较两组的手术效果。结果 改良组术中出血量和住院天数少于常规组，差异均有统计学意义(P<0.05)；术后痛觉、温度觉、触压觉评分高于常规组，差异有统计学意义(P<0.05)，二点分辨觉距离小于常规组，差异有统计学意义(P<0.05)，外观形态和VAS评分高于常规组，差异有统计学意义(P<0.05)，术后并发症少于常规组，差异有统计学意义(P<0.05)。结论 改良骨间背侧动脉穿支游离皮瓣修复手部掌侧软组织缺损效果明显，可有效减少术后并发症，提高患者恢复速度，同时还能改善感觉功能恢复，提高术后美观效果。
[关键词]手部掌侧损伤；软组织缺损；皮瓣修复；穿支皮瓣；骨间背侧动脉
[中图分类号] R658.2 [文献标识码] A [文章编号] 1674-4721(2018)6(a)-0090-03
[Abstract]Objective To study the clinical effects of modified interosseous dorsal artery free perforator flaps in the repair of soft tissue defect of hand palm and its influence on postoperative sensory function and appearance morphology.Methods A total of 30 cases of patients with soft tissue defect of hand palm admitted to our hospital from January to December 2017 were selected for the study subjects and were divided into the modified group (n=15) and the routine group (n=15) according to system randomization method.The modified group was given modified interosseous dorsal artery free perforator flaps repair，and the routine group was given interosseous dorsal artery free perforator flaps repair.The surgical effects were compared between the two groups.Results The intraoperative blood loss and hospital stay in the modified group were lower than those in the routine group(P<0.05).The scores of postoperative pain，temperature sensation and touch pressure sensation were higher than those in the routine group(P<0.05)，while the two-point resolution distance was lower than that in the routine group (P<0.05)，and the scores of appearance and VAS were higher than those in the routine group(P<0.05)，while the postoperative complications were lower than those in the routine group，the differences were statistically significant (P<0.05).Conclusion Modified interosseous dorsal artery free perforator flaps can have good effects in the repair the soft tissue defects of the hand palm，and it can not only effectively reduce the postoperative complications and promote patient rehabilitation，but also improve the sensory function recovery and postoperative esthetic effect.
[Key words]Hand palmar injury；Soft tissue defect；Flaps repair；Perforator flaps；Interosseous dorsal artery
手部掌侧软组织损伤是日常生活中常见外伤，主要由机械外力作用所致，其中缺损严重者不仅影响手部外观，还可导致感觉和运动异常，影响患者生活质量[1]。随着微创手术和整形技术逐渐发展成熟，患者自体组织皮瓣移植已在临床广泛使用，可有效修复创伤缺损，减轻手部功能障碍，并一定程度改善其形態外观[2]。传统皮瓣移植术供区选择性较多，如掌背动脉岛状皮瓣、旋髂浅动脉穿支皮瓣等，其中前臂骨间背侧动脉皮瓣手术效果较好，获得临床广泛认可，但在临床仍有术后存活困难、感觉功能恢复不理想、易形成臃肿等问题[3-4]。本文在总结过往临床经验基础上，对骨间背侧动脉皮瓣移植现有缺点进行改良并取得一定临床效果，现报道如下。, 百拇医药(郑佐慧 谭志伟 肖志林 郑永才 罗焕明 梁晓兰 冯经旺)
[关键词]手部掌侧损伤；软组织缺损；皮瓣修复；穿支皮瓣；骨间背侧动脉
[中图分类号] R658.2 [文献标识码] A [文章编号] 1674-4721(2018)6(a)-0090-03
[Abstract]Objective To study the clinical effects of modified interosseous dorsal artery free perforator flaps in the repair of soft tissue defect of hand palm and its influence on postoperative sensory function and appearance morphology.Methods A total of 30 cases of patients with soft tissue defect of hand palm admitted to our hospital from January to December 2017 were selected for the study subjects and were divided into the modified group (n=15) and the routine group (n=15) according to system randomization method.The modified group was given modified interosseous dorsal artery free perforator flaps repair，and the routine group was given interosseous dorsal artery free perforator flaps repair.The surgical effects were compared between the two groups.Results The intraoperative blood loss and hospital stay in the modified group were lower than those in the routine group(P<0.05).The scores of postoperative pain，temperature sensation and touch pressure sensation were higher than those in the routine group(P<0.05)，while the two-point resolution distance was lower than that in the routine group (P<0.05)，and the scores of appearance and VAS were higher than those in the routine group(P<0.05)，while the postoperative complications were lower than those in the routine group，the differences were statistically significant (P<0.05).Conclusion Modified interosseous dorsal artery free perforator flaps can have good effects in the repair the soft tissue defects of the hand palm，and it can not only effectively reduce the postoperative complications and promote patient rehabilitation，but also improve the sensory function recovery and postoperative esthetic effect.
[Key words]Hand palmar injury；Soft tissue defect；Flaps repair；Perforator flaps；Interosseous dorsal artery
手部掌侧软组织损伤是日常生活中常见外伤，主要由机械外力作用所致，其中缺损严重者不仅影响手部外观，还可导致感觉和运动异常，影响患者生活质量[1]。随着微创手术和整形技术逐渐发展成熟，患者自体组织皮瓣移植已在临床广泛使用，可有效修复创伤缺损，减轻手部功能障碍，并一定程度改善其形態外观[2]。传统皮瓣移植术供区选择性较多，如掌背动脉岛状皮瓣、旋髂浅动脉穿支皮瓣等，其中前臂骨间背侧动脉皮瓣手术效果较好，获得临床广泛认可，但在临床仍有术后存活困难、感觉功能恢复不理想、易形成臃肿等问题[3-4]。本文在总结过往临床经验基础上，对骨间背侧动脉皮瓣移植现有缺点进行改良并取得一定临床效果，现报道如下。, 百拇医药(郑佐慧 谭志伟 肖志林 郑永才 罗焕明 梁晓兰 冯经旺)