de Meeus J B, Duport G, Lacroix P, Gayet L E
Service de Gynécologie-Obstétrique, Hôpital Jean Bernard, CHU, Poitiers.
Ann Chir Main Memb Super. 1992;11(2):126-31.
So-called "Raynaud's distal ischaemic phenomena of the upper limb may be responsible for disabling functional impairement and even lesions requiring amputation of one or several fingers. The ulnar artery is usually involved in these phenomena because of its anatomical position and its importance in the blood supply of the hand and the fingers. The authors present three clinical cases of distal ischaemia of the upper limb due to obliteration of the ulnar artery at the wrist, treated by microsurgical vein graft. A review of the literature revealed only 23 well documented cases of this type of treatment, i.e. 10% of all treatment options, which gave 95 to 100% of favourable results. The three patients in our series, reviewed after 2, 3 and 5 years, were considered to be cured. Although the severity of the disease can be evaluated by the clinical course, arteriography appears to be the key examination for diagnosis, prognosis and choice of treatment. However, two practical attitudes are recommended to avoid the risk of progression towards digital necrosis: when the symptoms are chronic, arteriography is indicated in the case of resistance to medical treatment or immediately in the case of unstable symptoms. The diagnosis of occlusion of the ulnar artery at the wrist then justifies treatment by microsurgical vein graft; when the symptoms are acute, treatment should preserve as much as possible the palmar and digital ulnar arterial blood supply.
所谓“上肢雷诺氏远端缺血现象”可能导致功能障碍，甚至出现需要截除一根或多根手指的病变。尺动脉通常会出现这些现象，这是由于其解剖位置以及在手部和手指血液供应中的重要性。作者介绍了3例因腕部尺动脉闭塞导致上肢远端缺血的临床病例，采用显微外科静脉移植术进行治疗。文献回顾显示，这种治疗方式仅有23例记录完整的病例，即占所有治疗方案的10%，其有效率为95%至100%。我们系列中的3例患者在术后2年、3年和5年接受复查，均被认为已治愈。尽管疾病的严重程度可通过临床病程进行评估，但动脉造影似乎是诊断、预后评估及治疗选择的关键检查。然而，为避免发展为手指坏死的风险，建议采取两种实用的态度：当症状为慢性时，若药物治疗无效则需进行动脉造影，若症状不稳定则应立即进行；腕部尺动脉闭塞的诊断确定后，采用显微外科静脉移植术进行治疗是合理的；当症状为急性时，治疗应尽可能保留手掌和手指的尺侧动脉血供。
