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手指血管损伤:单动脉供血与双动脉供血的临床比较

Blood Vessel Injuries of the Fingers: A Clinical Comparison of One- and Two-Arterial Blood Supply.

作者信息

Dastagir Nadjib, Obed Doha, Bucher Florian, Murad Shiar, Dastagir Khaled, Vogt Peter M

机构信息

Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625 Hannover, Germany.

出版信息

J Clin Med. 2023 Sep 11;12(18):5889. doi: 10.3390/jcm12185889.

Abstract

Traumatic finger injuries are very common in emergency medicine. When patients present with finger injuries, there is often damage to the vascular nerve bundles, which requires subsequent reconstruction. It is unknown if repairing a unilaterally injured artery affects patients' recovery in a well-perfused finger. This retrospective cohort study compares the clinical outcomes of 11 patients with one-vessel supply (mean age 48.3 years; 7 males, 4 females) to 14 patients with two-vessel supply (mean age 44.5 years; 8 males, 6 females). The patient outcomes were assessed using patient questionnaires (Disabilities of Arm, Shoulder, and Hand (DASH), European Quality of Life 5 Dimensions 5 Level Version (EQ-5D-5L), and EuroQol visual analog scale (EQ-VAS)) and a clinical examination of hand function and imaging of circulatory efficiency. No significant changes were observed in the DASH, EQ-5D-5L, and EQ-VAS questionnaires. Clinical evaluation of hand function, measured by cold sensitivity, two-point discrimination, pain numerical analog scale, and grip strength also revealed no significant differences between cohorts. Blood flow measurements using thermal imaging revealed no effects on circulation in the affected digit. Collectively, the study finds reconstruction is not absolutely necessary when there is one intact digital artery as it is sufficient for healing and functional outcomes. We recommend finger artery reconstruction when both digital arteries are injured or if an immediate tension-free suture is possible.

摘要

创伤性手指损伤在急诊医学中非常常见。当患者出现手指损伤时,血管神经束往往会受损,这就需要后续进行重建。对于灌注良好的手指,修复单侧受损动脉是否会影响患者的恢复尚不清楚。这项回顾性队列研究比较了11名单血管供血患者(平均年龄48.3岁;男性7名,女性4名)与14名双血管供血患者(平均年龄44.5岁;男性8名,女性6名)的临床结局。使用患者问卷(手臂、肩部和手部功能障碍量表(DASH)、欧洲生活质量5维度5水平版本(EQ-5D-5L)和欧洲生活质量视觉模拟量表(EQ-VAS))以及手部功能临床检查和循环效率成像来评估患者结局。在DASH、EQ-5D-5L和EQ-VAS问卷中未观察到显著变化。通过冷敏感度、两点辨别觉、疼痛数字模拟量表和握力测量的手部功能临床评估也显示两组之间没有显著差异。使用热成像进行的血流测量显示对受影响手指的循环没有影响。总体而言,该研究发现当存在一条完整的指动脉时,重建并非绝对必要,因为这足以实现愈合和功能结局。我们建议在两条指动脉均受损或能够立即进行无张力缝合时进行手指动脉重建。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3226/10531927/699c99fee805/jcm-12-05889-g001.jpg

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