上肢严重复合伤中隐静脉移植修复血管的经验
Experience with saphenous vein graft for vascular repair in severe combined injury of upper limb
龙文浩 1邹汉宣 1蓝映 1施凤有 1程筱筠 1蓝婷婷 1封帆 1王伟明1
作者信息
- 1. 东莞市虎门医院树田总院手外科,广东东莞 523900
- 折叠
摘要
目的 探讨应用自体隐静脉移植术在上肢严重复合创伤中修复血管的临床体会.方法 对2018年3月-2022年10月收治的13例上肢严重复合创伤患者,采用自体隐静脉血管移植修复上肢严重损伤血管.其中肱动脉损伤6条,采用大隐静脉血管移植吻合修复;肱静脉损伤4条,采用大隐静脉或小隐静脉血管移植吻合修复;前臂桡动脉损伤4条,采用大隐静脉血管移植吻合修复;前臂静脉损伤1条,采用小隐静脉血管移植吻合修复.结果 13例采用自体静脉血管移植者术后并发症得到有效防控,未出现截肢或大面积皮肤组织坏死的情况.术后10例成功随访24个月以上,6例臂损伤者术后患肘恢复伸屈功能,上肢肌肉组织挛缩程度轻,外形饱满,色泽红润,感觉恢复至肘下5.0～16.0 cm;4例前臂损伤者术后尺神经运动及感觉功能得到恢复,手尺侧肌肉萎缩程度轻,拇指对指及各指活动恢复接近正常,指腹两点辨别觉最小恢复至3 mm.按照中华医学会手外科学会上肢再植功能评定试用标准进行评定:优9例,良3例,可1例.结论 自体静脉血管移植在伴有严重复合创伤的上肢血管损伤中可以减少术后并发症的发生,提高上肢严重复合伤患肢术后成活概率和功能恢复质量,临床效果良好.
Abstract
Objective To investigate the clinical effect of autosaphenous vein transplantation in severe compound trauma of upper limb.Methods From March 2018 to October 2022,a total of 13 patients with severe combined trauma of upper limbs were treated by our department.In the 13 cases,6 cases of brachial artery injury were repaired by great saphenous vein transplantation,4 cases of brachial vein injury were repaired by transplantation of great saphenous vein or small saphenous vein,4 cases of forearm radial artery injury were repaired by great saphenous vein transplantation.One case of forearm venous injury was repaired by small saphenous vein graft.13 patients with severe upper extremity complex injuries were repaired by autologous saphenous vein vascular transplantation.Results The postoperative complications were effectively prevented and controlled in 13 patients with autologous vein transplantation without amputation or necrosis of large area skin tissue.Autologous venous vascular transplantation can improve the survival rate and functional recovery quality of the extremity With severe compound injury of the 13 cases,10 were followed up successfully for more than 24 months after surgery:With the mild muscle tissue contracture,full shape and the ruddy color,6 cases of arm injury recovered the elbow extension and flexion function and restored the range of sensation to 16.0～5.0 cm below elbow after surgery.With mild ulnar hand muscle atrophy,4 cases of forearm injury recovered ulnar nerve movement and sensory function after surgery,the activity of thumb opposite finger and every finger was nearly normal as well as the discriminent range of two points in the finger abdomen was restored to 3 mm at least in which.According to the trial standard of upper limb replantation function evaluation of the Hand Surgery Society of the Chinese Medical Association,13 cases were cured,excellent in 9 cases,good in 3 cases.fair in 1 case.Conclusion The application of autologous venous vascular transplantation in the upper limb vascular injury with severe combined trauma can reduce the occurrence of postoperative complications,improve the survival rate of the affected limb and the level of postoperative functional recovery.Its clinical effect is great.
关键词
患肢再植/隐静脉移植/显微外科手术Key words
Limb replantation/Saphenous vein transplantation/Microsurgery引用本文复制引用
基金项目
东莞市社会科技发展一般项目(20211800900372)
出版年
2024
NETL
NSTL
万方数据