Application of digital artery transposition in replantation of fingers with vascular defects and its influence on nerve function and joint function recovery

doi:10.3877/cma.j.issn.1674-0785.2022.03.005

Abstract

Abstract:

Objective

To explore the application of digital artery transposition in replantation of fingers with vascular defects and its influence on nerve function and joint function recovery.

Methods

Two hundred patients who underwent replantation of severed fingers at Hengshui People's Hospital from July 2017 to July 2020 were selected and randomly divided into an arterial transposition group and a venous transplantation group according to the random number table method, with 100 cases in each group. The artery transposition group received finger artery transposition, while the vein graft group underwent autologous vein graft bridging. The clinical efficacy, operation time, survival rate of severed fingers, incidence of vascular crisis, functional recovery after replantation of severed fingers, and patient satisfaction were compared between the two groups.

Results

The clinically marked improvement rate (91.00% vs 81.00%) and patient satisfaction (96.00% vs 87.00%) in the arterial transposition group were significantly higher than those in the venous transplantation group (P＜0.05). Compared with the venous transplantation group, the operation time in the arterial transposition group [ (45.38±9.47) min vs (58.67±10.25) min ] was shorter, and the survival rate of fingers (95.00% vs 87.00%) was higher (P＜0.05). There was no significant difference in the incidence of vascular crisis between the two groups (19.00% vs 24.00%) (P＞0.05). The arterial transposition group had shorter two-point discrimination and better sensory function recovery than the venous transplantation group (P＜0.05). The activity scores of the metacarpophalangeal joint (MP), proximal interphalangeal joint (PIP), and distal interphalangeal joint (DIP), as well as the activities of daily living in the arterial transposition group were significantly better than those in the venous transplantation group (P＜0.05); however, there was no significant difference in the recovery of fingers between the two groups (P＞0.05). The blood circulation status and appearance recovery in the arterial transposition group were significantly better than those of the venous transplantation group (P＜0.05).

Conclusion

The efficacy and safety of digital artery transposition in replantation of fingers with vascular defects are good, and it can effectively improve the survival rate of fingers and the recovery of neurological function, joint function, and appearance.

Key words: Digital artery transposition, Finger replantation, Vascular defect, Neurological function, Joint function

Chunlai Xiao, Genqiang Bao, Guohui Zhang, Yulong Guan, Quan Wang, Hua Li. Application of digital artery transposition in replantation of fingers with vascular defects and its influence on nerve function and joint function recovery[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(03): 220-225.

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Figures/Tables 7

组别	例数	性别（男/女，例）	年龄（岁， $x ¯$ ±s）	致伤原因（电锯伤/碾压伤/撕脱伤，例）	受伤部位（拇指/示指/中指/环指/小指，例）	受伤平面（掌指关节/近节指骨/中节指骨/远节指间关节，例）	受伤时间（h， $x ¯$ ±s）
动脉转位组	100	61/39	33.85±8.96	24/29/47	12/31/24/30/3	15/25/28/24/8	2.93±0.96
静脉移植组	100	58/42	35.06±9.87	29/26/45	14/33/22/29/2	13/24/30/26/7	3.08±1.03
统计值		χ²=0.187	t=0.908	χ²=0.679	-	χ²=0.379	t=1.065
P值		0.666	0.365	0.712	0.894	0.984	0.288

组别	例数	性别（男/女，例）	年龄（岁， $x ¯$ ±s）	致伤原因（电锯伤/碾压伤/撕脱伤，例）	受伤部位（拇指/示指/中指/环指/小指，例）	受伤平面（掌指关节/近节指骨/中节指骨/远节指间关节，例）	受伤时间（h， $x ¯$ ±s）
动脉转位组	100	61/39	33.85±8.96	24/29/47	12/31/24/30/3	15/25/28/24/8	2.93±0.96
静脉移植组	100	58/42	35.06±9.87	29/26/45	14/33/22/29/2	13/24/30/26/7	3.08±1.03
统计值		χ²=0.187	t=0.908	χ²=0.679	-	χ²=0.379	t=1.065
P值		0.666	0.365	0.712	0.894	0.984	0.288

组别	例数	优	良	差	劣	临床优良率
动脉转位组	100	62（62.00）	29（29.00）	6（6.00）	3（3.00）	91（91.00）
静脉移植组	100	50（50.00）	31（31.00）	14（14.00）	5（5.00）	81（81.00）
χ²值						4.153
P值						0.042

组别	例数	手术时间（min， $x ¯$ ±s）	断指成活［例（%）］	血管危象［例（%）］
动脉转位组	100	45.38±9.47	95（95.00）	19（19.00）
静脉移植组	100	58.67±10.25	87（87.00）	24（24.00）
统计值		t=9.523	χ²=3.907	χ²=0.741
P值		0.001	0.048	0.389

组别	例数	手术时间（min， $x ¯$ ±s）	断指成活［例（%）］	血管危象［例（%）］
动脉转位组	100	45.38±9.47	95（95.00）	19（19.00）
静脉移植组	100	58.67±10.25	87（87.00）	24（24.00）
统计值		t=9.523	χ²=3.907	χ²=0.741
P值		0.001	0.048	0.389

组别	例数	指腹两点辨别觉（mm， $x ¯$ ±s）	感觉恢复（S₂/S₃/S₃₊/S₄，例）
动脉转位组	100	4.35±0.77	7/12/48/33
静脉移植组	100	5.96±0.83	19/19/33/19
统计值		t=14.221	Z=11.163
P值		0.001	0.011

组别	例数	指腹两点辨别觉（mm， $x ¯$ ±s）	感觉恢复（S₂/S₃/S₃₊/S₄，例）
动脉转位组	100	4.35±0.77	7/12/48/33
静脉移植组	100	5.96±0.83	19/19/33/19
统计值		t=14.221	Z=11.163
P值		0.001	0.011

组别	例数	手指ROM（°）			UEFT（分）
组别	例数	MP	PIP	DIP	UEFT（分）
动脉转位组	100	74.33±11.45	62.38±9.42	35.61±10.85	91.33±5.04
静脉移植组	100	65.89±9.76	59.47±10.56	32.11±8.97	89.42±4.76
t值		5.609	2.056	3.196	2.755
P值		0.001	0.041	0.002	0.006

组别	例数	血液循环状态（优/良/差/劣）	外观（优/良/差/劣）
动脉转位组	100	73/19/6/2	61/25/9/5
静脉移植组	100	61/23/9/7	48/29/10/13
Z值		3.913	4.316
P值		0.048	0.038

组别	例数	满意	基本满意	不满意	总满意率
动脉转位组	100	72（72.00）	24（24.00）	4（4.00）	96（96.00）
静脉移植组	100	55（55.00）	32（32.00）	13（13.00）	87（87.00）
χ²值					5.207
P值					0.022

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