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中华显微外科杂志
中山大学
中华显微外科杂志

中山大学

庞水发

双月刊

1001-2036

zhxwwk@mail.sysu.edu.cn

020-87330683

510080

广东省广州市中山二路74号中山大学北校区期刊大楼二楼

中华显微外科杂志/Journal Chinese Journal of MicrosurgeryCSCD北大核心CSTPCD
查看更多>>1978年8月创刊，中华医学会主办。本刊为我国惟一的显微外科专业性刊物，是中华医学会显微外科学会的学术性期刊；一直是中文核心期刊,被国内所有检索系统和数据库及WPRIM收录，被引频次、引文和影响因子等一直名列全国科技期刊前列。本刊及时报道国内外显微外科的新进展，反映我国显微外科水平和发展方向，同时积极介绍基层医院开展和普及显微外科的情况，适合从事显微外科、骨科、整形外科、手外科、神经外科、关节外科、泌尿外科、口腔颌面外科、眼科、耳鼻喉科、妇科、脊柱外科、腔镜和内镜的应用等手术学科及解剖学等基础医学专业人员投稿和阅读。
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    趾腓侧分叶穿支皮瓣拆分移植修复多发指端缺损

    董书男刘承伟江吉勇于玉芝...
    44-47页
    查看更多>>摘要：目的 探讨应用趾腓侧分叶穿支皮瓣拆分移植修复多发指端缺损的临床效果。 方法 自2019年1月至2022年6月，北京积水潭医院贵州医院上肢修复重建外科设计以同一趾供区第1跖背动脉为蒂的趾腓侧分叶穿支皮瓣拆分为趾背动脉皮瓣、趾底动脉皮瓣移植修复多发指端缺损15例，其中男10例，女5例，年龄20~45岁 拇、示指指端缺损8例，拇、中指指端缺损4例，拇、示、中指指端缺损2例，拇、示、环指指端缺损1例；15例多指指端缺损病例中均有1指合并需修复的甲床缺损。趾腓侧趾背动脉皮瓣切取面积1。8 cm×2。0 cm~2。0 cm×3。1 cm，趾底动脉皮瓣切取面积1。5 cm×2。0 cm~2。5 cm×3。0 cm。趾供区均以游离旋髂浅动脉穿支皮瓣修复。术后通过门诊、微信、电话随访手指外形、功能、感觉恢复情况。随访截止时间：2023年6月30日。 结果 本组15例皮瓣全部成活。术后随访6~24（平均16）个月，所有皮瓣外观、质地与健侧手指接近，指甲生长良好无畸形，皮瓣TPD为8。0~12。0 mm，足部供区旋髂浅动脉穿支皮瓣均成活，切口均愈合良好，供足行走、跑跳功能均未见明显影响。 结论 应用趾腓侧分叶穿支皮瓣拆分移植修复多发指端缺损，血管走行恒定，皮瓣切取简便，皮瓣质地接近正常手指，皮瓣可携带甲床，一个皮瓣供区可一次性修复两处指端缺损，是修复多发手指指端中、小面积复合组织缺损的一种较理想方法。 Objective To evaluate the clinical effectiveness of the reconstruction of multiple digit-tip defects with transfer of polyfoliate perforator flaps of the fibular hallux。 Methods From January 2019 to June 2022， 15 patients had undergone reconstruction surgery for multiple digit-tip defects using polyfoliate perforator flaps of ipsilateral fibular hallux， with the first dorsal metatarsal artery as the pedicle， in the Department of Upper Limb Repair and Reconstruction Surgery， Guizhou Hospital of Beijing Jishuitan Hospital。 The patients were 10 males and 5 females and aged 20 to 45 years old。 Eight patients had the defects of thumbs and index fingers， 4 of thumbs and middle fingers， 2 of thumb， index and middle fingers and 1 of thumb， index and ring fingers。 All the 15 digit injuries had nail bed defects to which reconstructive surgery were required。 For the flaps of dorsal artery， flaps were 1。8 cm×2。0 cm-2。0 cm×3。1 cm in size and for those of plantar artery， the flaps sized 1。5 cm×2。0 cm-2。5 cm×3。0 cm。 Donor site defects in the hallux were reconstructed with free superficial circumflex iliac perforator flaps。 Postoperative follow-up lasted until 30th June 2023 and included visits to the outpatient clinic， WeChat and telephone reviews to assess the appearance， function and sensation recovery of the digits。 Results All the 15 flaps survived。 During the 6 to 24 months (16 months in average) of postoperative follow-up， the appearance and texture of all flaps were found close to the healthy digits， with good nail growth and without deformity。 TPD were found between 8。0 mm and 12。0 mm。 The donor sites on the great toes that reconstructed with superficial circumflex iliac artery flaps were all survived well， and the incisions were satisfactorily healed without the functions of walking， running or jumping being significantly affected。 Conclusion The use of polyfoliate perforator flaps of fibular hallux for reconstruction of multiple digit-tip defects is an ideal surgical method due to the consistency of vascular anatomy， ease with flap harvest， similarity in the normal digital skin texture， and the capability to include a nail bed with the flap。 A single donor from the hallux can simultaneously reconstruct two defects of digit-tip， making it an excellent treatment in the reconstruction of small-to medium-sized composite tissue defects in multiple digits。

    指端缺损分叶穿支皮瓣第1跖背动脉显微外科技术

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    股外侧皮神经松解术治疗骨盆骨折引起的感觉异常性股痛

    吴佶歆孙嘉宇楚彬胡韶楠...
    48-52页
    查看更多>>摘要：目的 探讨在辅助检查下精确定位后，采用小切口行股外侧皮神经（LFCN）松解术治疗骨盆骨折引起的感觉异常性股痛（MP）的疗效。 方法 对复旦大学附属华山医院手外科2019年6月至2022年6月间的6位骨盆骨折合并MP的患者进行了回顾性研究。其中4例骨盆骨折为保守治疗，1例为钢板内固定术后，1例为螺钉内固定术后。平均手术时间为伤后5。33（3~7）个月。所有患者术前都行超声和CT检查以明确卡压点，行LFCN松解后，对其术前及术后3个月、1年内（7~11个月）进行门诊随访，并记录所有患者的视觉模拟评分（VAS）。运用SPSS 26。0数据统计分析软件进行数据分析与处理，数据以均数±标准差（Mean±SD）表示。采用Friedman检验比较6例患者术前、术后第1次及第2次随访VAS评分差异，若差异有统计学意义，则进一步行成对比较，并采用Bonferroni矫正法调整显著性水平。P<0。05为差异有统计学意义。 结果 6例患者在进行神经松解术后，第1次术后随访VAS均下降，皮肤感觉异常区域缩小明显；第2次随访除1例患者VAS仍有2分外，其余患者均为0分，与术前相比差异有统计学意义（Friedman检验：χ2=12。0，P=0。002；成对t检验：P=0。002）。 结论 对于骨盆骨折合并MP，较易通过辅助检查发现LFCN的卡压点，定位后对其进行小切口的精准松解能够起到迅速彻底缓解疼痛与感觉异常的效果。 Objective To evaluate the efficacy in decompression of lateral femoral cutaneous nerve (LFCN) through a small incision， following precise localisation with auxiliary examinations， in the treatment of meralgia paraesthetica (MP) caused by pelvic fractures。 Methods A retrospective study was conducted on 6 patients with MP caused by pelvic fractures at the Department of Hand Surgery， Huashan Hospital， Fudan University between June 2019 and June 2022。 Among the 6 patients with MP caused by pelvic fractures， 4 were treated conservatively， 1 received an internal fixation with a steel plate， and the other received an internal fixation with screws。 The average time after the injury to surgery was 5。33 (range: 3-7) months。 Preoperative ultrasound and CT scans were performed to identify the sites of compression on LFCN。 After the decompression of LFCN， Visual analog scale (VAS) scores were employed to compare the therapeutic effectiveness with what that before surgery， at 3 months and within 1 year (7-11 months) after surgery。 SPSS 26。0 data statistical was used analysis software for data analysis and processing， the data was represented as (Mean ± SD)。 Friedman test was used to compare the differences in VAS scores among 6 patients before surgery， at first postoperative follow-up， and second postoperative follow-up。 If the differences were statistically significant， pairwise comparisons were further conducted， and the Bonferroni correction method was used to adjust the significance level。 P<0。05 indicated a statistically significant difference。 Results After the LFCN decompression， all patients showed a decrease in VAS scores with significantly reduced area of skin paraesthesia at the first postoperative follow-up review。 At the second review， all patients scored VAS zero， except 1 who was scored 2。 There was a statistically significant difference compared to preoperative VAS scores (Friedman test: χ2=12。0， P=0。002 paired t-test: P=0。002)。 Conclusion For the meralgia paraesthetica caused by pelvic fractures， compression points on LFCN can be easily identified through auxiliary examinations。 Precise release of the LFCN from compression through a small incision， after an accurate localisation， provides a rapid and complete relief of pain and sensory abnormalities。

    股外侧皮神经骨盆骨折感觉异常性股痛神经松解

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    三叉神经痛个体化微血管减压手术策略分析

    洪文明陈东辉张芳汪惊涛...
    53-58页
    查看更多>>摘要：目的 探讨个体化微血管减压术（MVD）治疗三叉神经痛（TN）的临床疗效，以期为患者提供个体化治疗策略及新的治疗思路。 方法 回顾性分析2021年1月至2023年9月安徽医科大学第一附属医院神经外科收治的46例TN患者的临床资料，男19例，女27例；发病年龄为（58。3 ± 9。0）岁。根据巴罗神经学研究所(BNI)提出的疼痛分级评估患者术前疼痛分级及手术疗效。其中术前BNI Ⅳ级27例，Ⅴ级19例。46例患者手术均采用经乙状窦后入路，结合术中血管情况采取显微镜手术完成10例，内镜完成手术12例，内镜和显微镜双镜联合24例。探明责任血管后，予以涤纶垫棉减压。术后通过电话或者门诊跟踪随访患者。 结果 46例TN MVD患者，43例（93。5%）术后疼痛即刻完全缓解（BNI分级Ⅰ级），3例（6。5%）术后疼痛部分缓解（BNI分级Ⅱ级）。4例患者术后出现面部麻木、感觉减退，2例出现面瘫（House-Brackmann分级Ⅱ级1例、Ⅲ级1例），8例出现颅内积气，4例出现术后发热，2例皮下积液。经过治疗，颅内积气、发热均治愈，皮下积液1例消失，1例持续存在。46例患者随访中位时间为16。2（1~33）个月，3例术后BNI Ⅱ级患者2例完全缓解（BNI分级Ⅰ级），1例复发加重（BNI分级Ⅳ级）。 结论 责任血管的复杂程度是制定TN MVD策略的重要考量因素之一，结合术中具体血管情况制定个体化的手术方案，是TN治疗值得借鉴的手术策略。 Objective To investigate the clinical efficacy of individualised microvascular decompression (MVD) for trigeminal neuralgia (TN)， so as to provide individualised treatment strategies and new thoughts for treatment。 Methods Clinical data of 46 patients who had TN and treated in the Department of Neurosurgery at the First Affiliated Hospital of Anhui Medical University from January 2021 to September 2023 were retrospectively studied。 The study consisted of 19 males and 27 females， with an average age of morbidity at (58。3 ± 9。0) years old。 Preoperative pain ratings and surgical outcomes were evaluated using the Barrow Neurological Institute (BNI) pain rating scale， and of which 27 patients were rated at BNI grade IV and 19 at grade V before surgery。 A posterior trans-sigmoid sinus approach was applied in surgery on all patients， which could be performed in various ways depending on the vascular conditions identified during surgery。 Ten patients were treated with microsurgery， 12 with endoscopic surgery and 24 with combined endoscopic surgery and microsurgery。 After having identified the responsible vessel(s)， a vascular decompression for the affected trigeminal nerve was performed and the nerve decompression was achieved by a polyester pad。 Long-term postoperative follow-ups were conducted via telephone interviews or outpatient visits。 Results A total of 46 patients received the microvascular decompression surgery。 Among them， 43 cases (93。5%) achieved immediate and complete pain relief of BNI grade I after surgery， and 3 cases (6。5%) achieved partial pain relief of BNI grade Ⅱ。 Four patients developed facial numbness and sensory reduction， 2 developed facial paralysis (of House-Brackmann grade Ⅱ of 1 patient and grade Ⅲ of the other)， 8 developed pneumocephalus， 4 developed postoperative fever， and 2 developed subcutaneous effusion。 After treatment， the pneumocephalus and fever were cured， subcutaneous effusion was disappeared in 1 patient， but remained in the other。 The mean follow-up period for the 46 patients was 16。2 (1-33) months。 During the follow-up， 2 of the 3 patients of BNI grade Ⅱ immediately after surgery had complete remission to BNI grade Ⅰ and the other had recurrence and aggravation at BNI grade Ⅳ。 Conclusion The complexity of the responsible vessels is one of the important factors to be considered in the microvascular decompression strategy for trigeminal neuralgia。 An individualised surgical plan according to a specific vascular condition identified in the surgery， is a best possible or worthiness surgical strategy in the treatment for a TN。

    三叉神经痛微血管减压术神经显微手术神经内镜回顾性研究

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    修复足踝部的带蒂皮瓣坏死分级系统的建立与初步验证

    何晓清石岩段家章杨曦...
    59-64页
    查看更多>>摘要：目的 建立修复足踝部的带蒂皮瓣坏死分级系统，并初步验证其有效性和重复性。 方法 采用回顾性观察研究方法。以2010年1月至2022年1月期间，中国人民解放军联勤保障部队第九二〇医院骨科同一手术组完成的修复足踝部的带蒂皮瓣手术为基础，2位高年资医师选择40个病历资料完整的皮瓣坏死病例。由工作小组提出皮瓣坏死分级系统，并对40个病例进行分级。通过病例分级与治疗方法进行相关性研究，计算符合率，评价分级系统的有效性。40个病例中，每个病例选择1张典型术后坏死图片，请院外5位医生根据分级系统对图片进行分级；并将分级结果和标准分级进行加权Kappa分析，评价评分系统的重复性。计量资料以均值±标准差（Mean±SD）表示，符合率以百分率表示。 结果 本研究40个病例中，Ⅰ级7例，Ⅱ级16例，Ⅲ级12例，Ⅳ级5例。分级与实际治疗方法比较，总符合率92。5%，说明分级系统能有效指导治疗。5位医生分级的平均加权Kappa系数为0。628，95%置信区间（95%CI）为0。460~0。796，与标准分级有较强的一致性。 结论 本研究提出的修复足踝部的带蒂皮瓣坏死分级系统简单明了；经初步验证，分级系统能有效指导皮瓣坏死的治疗，且有较强的重复性。 Objective To develop a grading system for necrosis of pedicled flaps in reconstruction of foot and ankle， and to verify its effectiveness and repeatability。 Methods A retrospective observational study was conducted。 A total of 40 necroses of foot and ankle pedicled flaps were selected by 2 senior surgeons based on the flap surgery performed by the same surgical group in Department of Orthopaedic Surgery， the 920 Hospital of Joint Logistic Support Force of PLA from January 2010 to January 2022。 A grading system for pedicled flap necrosis was proposed by a working group and the 40 necrotic flaps were graded。 The coincidence rate was calculated to evaluate the effectiveness of the grading system through correlation studies between grading and clinical treatment。 One photo of a typical postoperative necrotic flap was collected from each of the 40 flaps。 Then 5 extramural surgeons were asked to grade the necroses shown on the photos according to the proposed grading system。 Moreover， weighted Kappa analysis was performed on the results of proposed grading system and also on the standard grading currently in use， to evaluate the repeatability of the proposed grading system。 Evaluated data were expressed by Mean±SD， and the coincidence rate was expressed by percentage。 The reproducibility was studied by weighted Kappa analysis。 Results Of the 40 necrotic flaps， 7 flaps were classified in Grade I， 16 in Grade Ⅱ， 12 in Grade Ⅲ and 5 in Grade IV。 In comparison with the actual treatment methods， the overall coincidence rate of the grading system was 92。5%。 It indicated that the proposed grading system could effectively guide the selection of a treatment procedure。 The average weighted Kappa coefficient of surgeons was at 0。628 with a 95% confidence interval (95%CI) between 0。460-0。796， which was strongly consistent with the standard of the grading system currently in use。 Conclusion The grading system for necrosis of pedicled flap in reconstruction of foot and ankle proposed in this study is simple and clear。 It is able to effectively guide the treatment of flap necrosis。 The preliminary validation shows that the classification system has good repeatability。

    足踝带蒂皮瓣分级坏死并发症

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    吻合弓上动脉的儿童指尖离断再植技巧及临床疗效

    熊胜吕永江华景辉黄小龙...
    65-70页
    查看更多>>摘要：目的 探讨吻合弓上动脉的儿童指尖离断再植技巧及其临床效果。 方法 2020年1月至2022年9月，对苏州瑞华骨科医院小儿骨科收治的62例62指儿童甲根部平面以远指尖完全离断进行再植，所有动脉断裂平面均位于动脉弓以远的弓上动脉处，弓上动脉口径在0。15~0。35 mm之间，术中均成功吻合弓上动脉，术毕及时通血，对术后坏死病例进行原因分析，对成活病例采取门诊复诊、微信、电话相结合的方式进行定期随访，随访内容包括指体饱满度、指骨间关节自主活动度、指甲生长情况、瘢痕增生情况以及再植指体对针刺的反应情况，并按断指再植功能评定试用标准进行临床效果评定。 结果 术后指体成活56例，其中2例术后发生伤口感染，经加强伤口换药及应用敏感抗生素后再植指体成活。坏死6例，其中2例行坏死指体解脱后远侧指骨间关节平面残端修整，4例因指体较小，坏死后予伤口换药，最终痂下愈合。52例获得随访（包括2例感染后换药成活病例及4例坏死后痂下愈合病例），10例失访（包括2例坏死后行残端修整病例），随访时间为2~30个月，平均6个月，再植指体外形、功能恢复良好；按断指再植功能评定试用标准评定：优44指，良6指，中2指。 结论 儿童指尖弓上动脉纤细，只要方法应用得当，均可以吻合，对于该平面的离断伤，再植术后疗效满意，临床上应尽量选择再植手术。 Objective To investigate the techniques of digit-tip replantation with anastomosis of superior digital arch artery in children and to evaluate the clinical effects。 Methods From January 2020 to September 2022， 62 children (62 digits) with completely severed digit-tips were admitted to the Department of Paediatric Orthopaedics， Suzhou Ruihua Orthopaedic Hospital。 All the injury planes were distal to the nail root。 All arterial dissections were distal to the digital arterial arch with the vessel calibre from 0。15 mm to 0。35 mm。 The superior arch arteries of the digital arterial arch were successfully anastomosed。 After surgery， a significant blood flux to the replanted digit body were observed。 Postoperative necroses or failures were analysed for the causes。 All children with survived digit-tips were entered into scheduled follow-ups through a combination of visit of outpatient clinics or via WeChat and telephone reviews。 Postoperative follow-up included digit body fullness， motion of distal interphalangeal joint， nail growth， scarring， and response of the replanted digit-tips to needling。 Clinical outcomes were evaluated according to the evaluation criteria for finger replantation function。 Results Of the 62 replanted digit-tips， 56 survived after replantation。 Two digits had wound infection after surgery， and survived by dressing change and applying sensitive antibiotics。 Necrosis occurred in 6 replanted digit-tips， of which 2 necrotic digit bodies were amputated， and the stumps at the distal interphalangeal joint were repaired。 The other 4 necrotic digits were healed after dressing change under the scab due to a smaller digit body。 A total of 52 children (including 2 survivals from postoperative infection after dressing changes and 4 survivals with healing underneath-eschar after necrosis) and with 10 lost during follow-up (including 2 with stump repairs after necrosis)。 The follow-up period ranged from 2 to 30 months， with an average of 6 months。 The shape and function of replanted digit-tips recovered well。 According to the evaluation criteria for finger replantation function， 44 digits were of excellent， 6 of good， and 2 of fair。 Conclusion In children， the superior arch arteries of digital arterial arches of the digit-tips are small in diameter。 However， the vessels in smaller calibres can be anastomosed， should proper surgical techniques are applied。 Therefore， due to the satisfactory outcomes， microsurgeons should try the best efforts to replant a digit severed at the plane of digit-tip。

    指尖离断弓上动脉再植血管口径儿童

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    两种同指带蒂皮瓣修复拇指指端或指腹创面的比较

    王辉王海峰白卫飞周彤...
    71-77页
    查看更多>>摘要：目的 比较同指桡侧指掌侧固有动脉（PPDA）背侧皮支皮瓣与同指尺侧指背动脉（DDA）逆行岛状皮瓣修复拇指指端或指腹创面的临床疗效。 方法 采用回顾性病例对照研究方法。自2016年1月至2022年8月，唐山市第二医院手外科收治65例拇指指端或指腹创面患者，分别采用桡侧PPDA背侧皮支皮瓣（PPDA背侧皮支组）修复35例（35指）、尺侧DDA逆行岛状皮瓣（DDA组）修复30例（30指）。PPDA背侧皮支组创面及皮瓣面积范围分别为1。9 cm×1。5 cm~2。9 cm×2。4 cm和2。1 cm×1。7 cm~3。1 cm×2。6 cm，DDA组创面及皮瓣面积范围分别为2。0 cm×1。7 cm~2。9 cm×2。5 cm和2。2 cm×1。9 cm~3。2 cm×2。8 cm。两组患者供区创面均直接缝合。术后观察两组患者皮瓣成活及供区切口愈合情况。记录两组患者手术时间及随访时间。患者随访采用门诊复查、电话及微信视频相结合的方式。末次随访时记录两组患者伤指关节主动总活动度（TAM）、虎口角、皮瓣静态TPD、皮瓣及供区外观满意度。患者皮瓣及供区外观满意度参照密歇根大学手部功能问卷（MHQ）评定标准评定。对两组计量资料行独立样本t检验，计数资料行χ2检验或Fisher精确检验，P<0。05为差异有统计学意义。 结果 PPDA背侧皮支组皮瓣35例全部一期成活，DDA组4例皮瓣出现水疱经伤口换药愈合，其余26例一期成活。PPDA背侧皮支组皮瓣一期成活率（100%）高于DDA组（87%），差异有统计学意义（P<0。05）。两组供区切口均一期愈合。PPDA背侧皮支组、DDA组患者手术时间及随访时间分别为（59。11±5。42）min、（15。37±3。32）个月和（61。27±5。96）min、（16。17±3。60）个月，两组比较差异均无统计学意义（P>0。05）。末次随访，PPDA背侧皮支组、DDA组患者伤指TAM和虎口角分别为（135。14±10。04）°、（90。29±4。36）°和（132。17±11。04）°、（89。00±4。81）°，两组差异无统计学意义（P>0。05）。PPDA背侧皮支组患者皮瓣静态TPD[（7。11±1。21）mm]、皮瓣外观满意度[（4。69±0。47）分]及供区外观满意度[（4。43±0。50）分]，好于DDA组TPD[（8。20±1。47）mm]、皮瓣外观满意度[（4。40±0。50）分]及供区外观满意度[（4。13±0。57）分]，两组差异有统计学意义（P<0。05）。 结论 桡侧PPDA背侧皮支皮瓣与尺侧DDA逆行岛状皮瓣均适用于修复拇指指端或指腹创面。相比尺侧DDA逆行岛状皮瓣，桡侧PPDA背侧皮支皮瓣一期成活率更高，皮瓣感觉与外观及供区外观更好。 Objective To compare the clinical effects between the homodigital radial flap of the dorsal cutaneous branch of radial palmar proper digital artery (PPDA) and the homodigital reverse island flap of the ulnar dorsal digital artery (DDA) on reconstruction of defects in thumb-tip or thumb-pulp。 Methods The retrospective case-control study method was used。 From January 2016 to August 2022， a total of 65 thumb-tip or thumb-pulp defects were treated in the Department of Hand Surgery of the Second Hospital of Tangshan。 Thirty-five defects of thumbs were reconstructed with the homodigital radial flap pedicled with dorsal cutaneous branch of radial PPDA (PPDA group) and the other 30 thumbs were treated by the homodigital ulnar reverse island flap pedicled with ulnar DDA (DDA group)。 Sizes of the wounds and flaps in PPDA group were 1。9 cm×1。5 cm to 2。9 cm×2。4 cm and 2。1 cm× 1。7 cm to 3。1 cm×2。6 cm， respectively， and the dimensions of the wounds and flaps in DDA group were 2。0 cm× 1。7 cm to 2。9 cm×2。5 cm and 2。2 cm×1。9 cm to 3。2 cm×2。8 cm， respectively。 The wounds of donor site in both groups were all directly closed。 Survival of the flaps and wound healing of donor sites were observed in both groups。 The time of surgery and duration of follow-up of the 2 groups were recorded。 Postoperative follow-up included outpatient clinic visits， telephone reviews and WeChat video-clips。 At the final follow-up， record of total active motion (TAM) of the injured thumbs， angle of first web of the affected hands， static TPD of the flaps， patient satisfaction of the appearance of flaps and donor sites were taken。 According to the Michigan Hand Function Questionnaire (MHQ) evaluation criteria， the patient satisfaction of the appearance of flaps and donor sites were evaluated。 The measurement and count data acquired from both groups were compared by independent sample t-test and χ2 tests or Fisher's exact test， respectively。P<0。05 was considered statistically significant。 Results All 35 flaps in PPDA group and 26 flaps in DDA group survived primarily， except 4 flaps in the DDA group that showed blisters and healed with dressing changes。 The primary survival rate of flap in PPDA group (100%) was higher than that of DDA group (87%)， and the difference was statistically significant (P<0。05)。 Donor sites of both groups healed primary。 The time of surgery and duration of follow-up in PPDA and DDA groups were 59。11 minutes±5。42 minutes and 15。37 months±3。32 months， and 61。27 minutes±5。96 minutes and 16。17 months±3。60 months， respectively。 There was no statistically significant difference between the 2 groups (P>0。05)。 At the final follow-up， the thumb TAM and angle of thumb web in PPDA and DDA groups were 135。14°±10。04° and 90。29°±4。36° and 132。17°±11。04° and 89。00°±4。81°， respectively。 There was no statistically significant differences between the 2 groups (P>0。05)。 The static TPD， patient satisfaction of the appearance of flaps and donor sites in PPDA group were 7。11 mm±1。21 mm， 4。69 point±0。47 point and 4。43 point±0。50 point， which were better than DDA group [8。20 mm±1。47 mm， 4。40 point±0。50 point and 4。13 point±0。57 point， respectively] with a statistically significant difference (P<0。05)。 Conclusion The homodigital radial flap of the dorsal cutaneous branch of radial PPDA and the homodigital ulnar reverse island flap of the ulnar DDA are both suitable for reconstruction of defects in thumb-tip or thumb-pulp。 Compared with the homodigital reverse island flap with the DDA， a homodigital radial flap with the dorsal cutaneous branch of PPDA has advantages in higher primary survival rate， better flap sensation and appearance at both of recipient and donor sites。

    外科皮瓣指掌侧固有动脉,背侧皮支指背动脉拇指损伤显微外科技术回顾性研究

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    Tamai I~II区指尖离断再植改良方法及临床疗效

    刘洋洋吴敏朱军高许斌...
    78-83页
    查看更多>>摘要：目的 探讨Tamai I~II区指尖离断再植的改良方法及临床疗效。 方法 自2019年11月至2022年10月，蚌埠医学院第一附属医院手足显微外科采用改良方法（放弃先解剖标记血管、神经，肉眼清创、骨折固定后，显微镜下一次性游离和修复血管、神经；甲侧襞辅助小切口探查吻合修复背侧静脉）对26例（29指）Tamai I~II区指尖离断再植。本组患者男20例（23指），女6例（6指）；年龄3~66岁，平均28岁。Tamai I区16例（19指），Tamai II区10例（10指），伤指指别：拇指7指，示指9指，中指5指，环指5指，小指3指。致伤原因：切割伤12例，挤压伤8例，撕脱伤6例。术后预防感染、解痉3 d，卧床休息5 d，统计患者手术时间；术后门诊随访患者6~12个月，包括成活率及外观、感觉恢复、运动和手指力量及患者满意度情况。 结果 ①手术时间：Tamai I区指尖离断再植时间约1。0 h；Tamai II区指尖离断再植时间约1。5 h。②成活率及外观：26例指尖离断再植全部成活（2例Tamai I区患指术后第2天静脉危象，小切口放血3 d后成活），22例患者指腹脂肪垫恢复，指腹较饱满，4例撕脱指尖离断，指腹轻度萎缩。Tamai I区15例患者指甲无畸形，较健侧短约2 mm；1例患者因术前甲床真菌感染，术后指甲外观不佳。③感觉恢复：采用英国医学研究会（BMRC）手指感觉评定标准，23例感觉恢复S3+；2例指尖撕脱指尖离断和1例挤压指尖离断患者感觉恢复S3。指尖离断患者指端TPD：切割伤患者4~7 mm；挤压伤患者6~8 mm；撕脱伤患者9~11 mm。④运动和手指力量：按我国手外科学会推行总主动活动度标准进行功能评定：优21例，良5例，手指捏持、握拿时指腹无疼痛。Tamai I区指尖离断患者手指活动度与健侧接近；5例Tamai II区指尖离断，因经远侧指骨间关节处离断，主动伸直0°、屈曲2°~3°。⑤患者满意度调查：满意25例，1例Tamai II区拇指指尖离断患者对指骨间关节活动度不满意。 结论 Tamai I~II区指尖离断采用改良再植方法，肉眼清创、骨折固定（肌腱缝合）后，显微镜下一次性游离和修复血管、神经，手术时间明显缩短。Tamai I区指尖离断甲侧襞辅助小切口，方便暴露恒定、较健康的甲侧襞静脉，吻合高质量静脉，提高再植成活率。切割伤指尖离断较撕脱、挤压伤指尖离断手指外形和功能恢复好。 Objective To explore the clinical effect of a modified surgical procedure for replantation of severed digit-tips in Tamai zones I-II。 Methods From November 2019 to October 2022， the Department of Hand and Foot Microsurgery of the First Affiliated Hospital of Bengbu Medical College employed a modified procedure (to abandon the anatomically labelling of blood vessels and nerves after naked-eye debridement and fracture fixation， then perform the microscopic dissections and anastomoses of blood vessels and nerves， and the anastomosis of dorsal veins though an auxiliary small incision by the lateral nail fold of the severed digit-tip) to replant severed digit-tips in Tamai zones I-II of 26 patients (29 digits)。 The patients were 20 males (23 digits) and 6 females (6 digits)， aged 3-66 years old， with mean age at 28 years old。 Nineteen digit-tips were severed in Tamai zone I and 10 in Tamai zone II。 The severed digit-tips were 7 of thumbs， 9 of index fingers， 5 of middle fingers， 5 of ring fingers and 3 of little fingers。 Causes of injury were 12 of cut， 8 of crush and 6 of avulsion。 Postoperative management included infection prevention， antispasmodic for 3 days and keeping in bed for 5 days。 The time of surgery was recorded on all patients。 Postoperative follow-ups were conducted at outpatient clinics for 6 to 12 months to observe the survival of digit-tips and the appearance， recovery of sensation and motor functions， strength of digits and patient satisfaction。 Results (1)The surgical time was about 1。0 hour for replantation of a severed digit-tip in Tamai zone I， while it took about 1。5 hours for those in Tamai zone II。 (2)Survival rate and appearance: all 29 replanted digit-tips survived， except 2 in Tamai zone I which encountered venous occlusion and survived after small incision for bloodletting。 Twenty-two digit-tips gained pulp fat pads with full digit pulps。 Four avulsed digit-tips had mild atrophy of pulp。 The 15 digit-tips severed in Tamai zone I were about 2 mm shorter than the healthy sides， but without deformity。 One digit-tip had poor nail appearance due to preoperative fungal infection of nail bed。 (3)Sensory recovery: with the British Medical Research Council (BMRC)， 23 digit-tips recovered to S3+， and 2 digit-tips of avulsion and 1 digit-tip of crush recovered to S3。 TPD of the replanted digit-tips were: 4-7 mm in those of cut injury 6-8 mm in those of crush and 9-11 mm in those of avulsion。 (4)Motion and digit strength: results of functional assessment according to the total active mobility standard promoted by China's Society for Surgery of the Hand were: 21 cases of excellent and 5 of good， without pain in digit pulp when pinching and griping。 The mobility of the digits with replanted digit-tips of both Tamai zones I and II were close to that of the healthy sides。 The motions of the digits with replanted digit-tips in Tamai zone I were close to the healthy sides and the 5 of those in Tamai zone II had 0° in extension and 2°-3° in flexion， due to the severed plane at distal interphalangeal joint。 (5)Patient satisfaction: 25 patients were satisfied， however 1 patient was dissatisfied to the poor function of the distal interphalangeal joint due to the severed thumb-tip in Tamai zone II。 Conclusion Modified replantation procedure for severed digit-tip in Tamai zones I-II has significant achievement in cutting down the surgical time through a modified procedure of debridement and fracture fixation (tendon suture) by naked-eyes operation first， followed by dissections and anastomoses of the blood vessels and nerves under the surgical microscope。 The auxiliary small incision by the lateral nail fold of digit-tip in Tamai zone I facilitates an exposure of a constant， healthy lateral nail fold vein。 It enables the anastomosis with a high-quality vein， hence improves the success rate of replantation。 The appearance and function of the replanted digit-tip are found better in the severed digit-tips of cut injury than those with injuries of avulsion and crush。

    断指再植指尖离断Tamai分区显微外科技术

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    带血管蒂掌骨瓣植入手舟骨近极联合内固定及韧带修复经舟骨月骨周围脱位

    于胜军原嘉漪李晓马振杰...
    84-88页
    查看更多>>摘要：目的 探讨带血管蒂掌骨瓣植入手舟骨近极联合内固定及韧带修复经舟骨月骨周围脱位（TSPFD）的手术方法及临床疗效。 方法 2015年2月至2021年7月，烟台市烟台山医院手外科采用带血管蒂第2掌骨骨瓣植入手舟骨近极联合内固定及韧带修复治疗TSPFD患者7例。所有患者均为后脱位，手术均采用腕背侧弧形切口，手舟骨骨折及腕骨脱位采用克氏针固定，选择第2掌背动脉蒂骨瓣植入手舟骨近极；韧带修复7例，其中舟月韧带直接缝合5例，采用Mitek锚钉修复舟月韧带1例，锚钉同时修复舟月韧带和月三角韧带1例。术后定期门诊、微信随访，采用Cooney评定标准评定腕关节功能。 结果 7例均获随访，随访时间17~35个月，平均23个月。所有病例X线片显示手舟骨均获得骨性愈合，骨愈合时间平均为18。6周。4例腕关节活动范围正常，2例腕关节活动范围轻度减小，活动时有轻微不适，1例患者重体力活动后出现轻度疼痛。所有患者没有明显的舟月分离、腕骨高度塌陷，无手舟骨、月骨坏死及创伤性关节炎表现；根据Cooney评定标准评定：优4例，良2例，可1例；腕关节主动屈伸活动度（121。9±7。2）°，尺偏活动度（21。6±2。8）°，桡偏活动度（16。5±1。8）°，背伸（47。10±5。47）°，握力（26。2±3。7）kg，为对侧的70%。 结论 带血管蒂掌骨瓣植入手舟骨近极联合内固定、韧带修复治疗TSPFD，手术方法简单，疗效可靠，值得临床推广。

    掌骨瓣腕骨经舟骨月骨周围脱位骨折固定术

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    神经电生理辅助下经乙状窦后入路显微切除岩斜区大型脑膜瘤的疗效及手术技巧

    蒋广义张龙洲王彪任军伟...
    88-92页
    查看更多>>摘要：目的 探讨在神经电生理辅助下经乙状窦后入路切除岩斜区大型脑膜瘤的显微外科治疗疗效，总结显微外科手术经验。 方法 回顾分析2016年6月至2022年6月，郑州大学第一附属医院神经外科收治的经显微神经外科治疗的42例岩斜区大型脑膜瘤患者的临床资料。采用乙状窦后入路切除岩斜区脑膜瘤，术中神经电生理监测辅助保护脑神经以及脑干功能。分析肿瘤切除程度及手术前、后神经功能状况的变化。通过门诊和电话联系的方式随访患者术后恢复情况。 结果 42例患者中肿瘤全切除（Simpson Ⅰ、Ⅱ）36例（85。7%），次（近）全切除6例（14。3%）。术后随访至2023年10月，随访率100%，随访时间（55。8±8。6）个月，术后出现新发神经或原有神经功能障碍明显加重22例（52。4%），无症状改变的14例（33。3%），症状好转的6例（14。3%）；术后脑脊液漏1例，皮下积液2例，经保守处理后均恢复；无昏迷及死亡病例。 结论 乙状窦后入路简便迅速、安全、损伤少，术野开阔，能够切除大部分岩斜区大型脑膜瘤；术中脑神经及脑干电生理监测是手术成功的保障。

    岩斜区脑膜瘤神经电生理监测乙状窦后入路显微外科手术回顾性研究

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    完全断指再植术后缩短患者卧床时间的干预性研究

    于晓凤李娇陈欧朱磊...
    93-97页
    查看更多>>摘要：目的 探究完全断指再植术后缩短患者卧床时间的可行性，并设计出一套缩短患者卧床时间的具体方案。 方法 根据纳入排除标准，采用方便抽样选取2020年11月至2022年11月山东大学齐鲁医院手足外科72例因外伤致1~2指完全离断的患者，其中试验组37例，对照组35例。对照组进行手足外科断指再植术后常规护理，试验组在术后常规护理的基础上，执行早期下床计划，将绝对卧床7 d以上更改为5 d可离床活动。观察两组患者血管危象、断指再植成活及便秘发生情况；通过舒适量表评分、焦虑自评量表评分（SAS）及抑郁自评量表评分（SDS）比较患者心理状况。采用卡方检验考察血管危象发生率、再植手术成功率、便秘发生率等计数资料；采用独立样本t检验，对焦虑、抑郁、舒适度得分等计量资料进行两组间比较，以P<0。05为差异具有统计学意义。 结果 试验组患者无血管危象发生，对照组有1例发生血管危象；两组再植指全部成活；血管危象发生率和断指再植成活率差异无统计学意义（P>0。05）；试验组的焦虑得分、抑郁得分[分别为（37。3±8。2）分和（43。0±8。3）分]均显著低于对照组[分别为（44。4±11。0）分和（48。8±8。6）分]（P<0。05）；舒适度得分[（88。8±10。5）分]高于对照组[（79。4±1。4）分]（P<0。05）。 结论 针对切割伤和轻度挤压伤致完全断指再植患者，采取循序渐进的下床方案，缩短了患者卧床时间，在保障患者安全的前提下，提升患者的舒适度，对断指再植成功率无负面影响，值得临床推广应用。

    断指再植护理卧床时间显微外科护理

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