吻合单根动脉指尖再植侧支回流解剖学和流体力学研究

发布时间：2018-04-16 17:18

本文选题：再植术 + 侧支　；参考：《广州医学院》2012年硕士论文

【摘要】：目的研究末节指动脉侧支的解剖学特点，探讨吻合单根动脉指尖再植的侧支回流的流体力学机制。方法对10只新鲜成人尸体手标本进行乳胶灌注，显微解剖观测手指末节指动脉侧支的数量、侧支起始处的外径。对5支手的指动脉铸型标本进行观测，测量末节指动脉侧支和主干的角度。用简易装置建立模拟吻合单根动脉指尖再植流体力学模型，观察理想液体的侧支回流现象。对85指仅吻合单根动脉指尖再植病例进行总结。结果指动脉末节侧支数为12.7±3.2，侧支外径为0.32±0.08mm。约60.3%的末节指动脉侧支与主干的角度在30°～60°之间，指动脉弓处侧支与主干的角度接近90°。从模拟吻合单根动脉指尖再植流体力学模型上观察到理想液体的侧支回流现象。临床上85指指尖再植病例，成活81指，坏死4指，成活率为95.3%。结论指动脉吻合口近端有一定数量的侧支存在，在指尖再植术中应尽量保留指动脉吻合口近端侧支，尽量缩短指动脉吻合口与侧支的距离。动脉侧支回流现象可用流体力学的伯努利定律（ρgh+ρv2+p=C）分析，这种现象是吻合单根动脉指尖再植成活的主要机制。
[Abstract]:PurposeTo study the anatomical characteristics of the collateral branches of the distal phalanx artery and to explore the hydrodynamic mechanism of collateral reflux from the anastomosed fingertips of a single artery.MethodTen fresh adult cadavers were perfused with latex. The number of the lateral branches of the digital artery and the external diameter at the beginning of the lateral branches were observed by microdissection.To measure the angle of the lateral branch and trunk of the digital artery of the terminal phalanx, the cast specimens of the digital artery of 5 hands were observed.A simple hydrodynamic model was established to simulate the replantation of the fingertip anastomosed with a single artery to observe the phenomenon of collateral reflux of ideal liquid.The replantation of 85 fingers with only one artery tip anastomosed was summarized.ResultThe number of branches at the end of the digital artery was 12.7 卤3.2, and the external diameter of the lateral branch was 0.32 卤0.08mm.About 60.3% of the distal phalanx artery had an angle between the lateral branch and the main artery between 30 掳and 60 掳, and the angle between the lateral branch and the main artery at the arch of the digital artery was nearly 90 掳.The phenomenon of collateral reflux of ideal liquid was observed from the hydrodynamic model of simulated anastomosis of the fingertip of a single artery.In 85 finger replantation cases, 81 fingers survived and 4 fingers were necrotic, the survival rate was 95.3%.ConclusionThere are a certain number of lateral branches in the proximal end of the anastomosis of digital artery, so the distance between the anastomosis of digital artery and the lateral branch should be kept as far as possible in the replantation of finger tip.The phenomenon of arterial collateral reflux can be analyzed by the Bernoulli's law of hydrodynamics (蟻 gh 蟻 v 2pc), which is the main mechanism of anastomosis of the finger tip of a single artery.
【学位授予单位】：广州医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322;R658

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