發(fā)布時(shí)間：2018-08-12 19:40

【摘要】：目的：探索游離雙側(cè)“手槍”狀股前外側(cè)皮瓣一期一次性瓦合修復(fù)全手脫套傷的可行性。方法：本研究包括建立模型、活體測(cè)量實(shí)驗(yàn)、尸體模擬修復(fù)實(shí)驗(yàn)以及臨床應(yīng)用4部分。建立模型：選取2具無(wú)手部殘疾和疾病的新鮮尸體標(biāo)本,選左手為模型手。以腕部遠(yuǎn)側(cè)腕橫紋、拇指橈側(cè)、小指尺側(cè)側(cè)中線(xiàn)為界,于伸屈肌腱表面完整切除掌、背側(cè)2部分皮膚,形成全手脫套傷傷情模型。在傷情模型基礎(chǔ)上,保留基本手功能單位(包括手掌、手背、全拇指和保留指淺屈肌腱止點(diǎn)的中指中節(jié)中部以近部份),余手指于掌指關(guān)節(jié)平面以遠(yuǎn)截除,形成修復(fù)模型。將修復(fù)模型創(chuàng)面分為掌側(cè)區(qū)和背側(cè)區(qū)2部分,設(shè)想用雙側(cè)股前外側(cè)皮瓣分別修復(fù)掌側(cè)區(qū)和背側(cè)區(qū)�；铙w測(cè)量實(shí)驗(yàn)：隨機(jī)選取50例(男、女各25例)健康、無(wú)手部殘疾和疾病的成年人,根據(jù)修復(fù)模型,分別測(cè)量基本手功能單位的掌側(cè)區(qū)和背側(cè)區(qū)皮膚的縱長(zhǎng)和橫寬；查閱相關(guān)股前外側(cè)皮瓣的專(zhuān)業(yè)教材以及文獻(xiàn),得到股前外側(cè)皮瓣最大可切取縱長(zhǎng)、橫寬；統(tǒng)計(jì)學(xué)處理,比較股前外側(cè)皮瓣與基本手功能單位掌側(cè)區(qū)、背側(cè)區(qū)各皮膚徑線(xiàn)的大小。尸體模擬修復(fù)實(shí)驗(yàn)：根據(jù)修復(fù)模型創(chuàng)面形狀在大腿供區(qū)設(shè)計(jì)切取雙側(cè)“手槍”狀股前外側(cè)皮瓣瓦合修復(fù)模型手,觀察修復(fù)效果。臨床應(yīng)用：重點(diǎn)闡述供區(qū)皮瓣與受區(qū)患手血供及感覺(jué)的建立方法和注意事項(xiàng)。結(jié)果：基本手功能單位掌側(cè)區(qū)皮膚縱長(zhǎng)為13.84±0.88cm,橫寬為14.48±1.11cm。背側(cè)區(qū)皮膚縱長(zhǎng)為12.15±1.09cm,橫寬為14.92±1.11cm。查閱資料得股前外側(cè)皮瓣最大可切取縱長(zhǎng)為30.59±6.21cm,橫寬為16.33±3.27cm。結(jié)果顯示：股前外側(cè)皮瓣可切取縱長(zhǎng)、橫寬均大于基本手功能單位掌、背側(cè)區(qū)皮膚的縱長(zhǎng)、橫寬。根據(jù)修復(fù)模型創(chuàng)面形狀設(shè)計(jì)及切取雙側(cè)“手槍”狀股前外側(cè)皮瓣,修復(fù)“修復(fù)模型”,獲得了滿(mǎn)意的修復(fù)手外形。結(jié)果提示：雙側(cè)“手槍”狀股前外側(cè)皮瓣瓦合后能覆蓋全手脫套傷修復(fù)模型創(chuàng)面。結(jié)論：瓦合雙側(cè)“手槍”狀股前外側(cè)皮瓣能一期一次性修復(fù)全手脫套傷。修復(fù)手擁有基本手功能和較滿(mǎn)意的外形。
[Abstract]:Objective: to explore the feasibility of one-stage tipping with free bilateral "pistol" anterolateral thigh flap to repair the whole hand degloving injury. Methods: this study included four parts: model establishment, in vivo measurement experiment, cadaveric simulated restoration experiment and clinical application. Model: two fresh cadavers without hand disability and disease were selected and left hand was chosen as model hand. The lateral striae of wrist, the radial side of thumb and the middle line of ulnar side of small finger were taken as the boundary, the palmar was removed completely on the surface of extensor and flexor tendon, and 2 parts of skin were removed from the dorsal side to form the injury model of the whole hand. On the basis of injury model, the basic functional units of hand (including palm, back of hand, total thumb and middle segment of middle finger of flexor digitorum tendinum) were retained, and the remaining fingers were amputated from the metacarpophalangeal joint to form a repair model. The model wounds were divided into two parts: metacarpal region and dorsal region. Bilateral anterolateral femoral flap was used to repair the metacarpal region and dorsal area respectively. In vivo measurement experiment: 50 healthy adults (25 males and 25 females) without hand disability and disease were randomly selected to measure the longitudinal length and transverse width of the palmar and dorsal regions of the basic hand functional units according to the repair model. The length and width of the anterolateral thigh flap were obtained by consulting the relevant teaching materials and literature. Statistical analysis was made to compare the diameter of each skin line between the anterolateral femoral flap and the basic functional units of the hand palmar and dorsal. Simulated repair experiment of cadaver: according to the shape of repairing model wound, the model hands of bilateral "pistol-like" anterolateral thigh flap were designed in the thigh donor area to observe the effect of repair. Clinical application: the establishment method and attention of blood supply and feeling of donor flap and recipient hand were expounded. Results: the longitudinal length and transverse width of the palmar area were 13.84 鹵0.88 cm and 14.48 鹵1.11 cm respectively. The longitudinal length and transverse width of dorsal skin were 12.15 鹵1.09 cm and 14.92 鹵1.11 cm respectively. The maximum longitudinal length and transverse width of anterolateral femoral flap were 30.59 鹵6.21 cm and 16.33 鹵3.27 cm respectively. The results showed that the longitudinal length and transverse width of the anterolateral thigh flap were larger than those of the basic hand functional unit palmar and the longitudinal and transverse width of the dorsal skin. According to the shape of the repair model, the bilateral "pistol-like" anterolateral thigh flap was designed and cut, and the "repair model" was repaired. The satisfactory hand shape was obtained. The results suggest that bilateral "pistol" anterolateral thigh flap can cover the wound surface of the model. Conclusion: bilateral "pistol" anterolateral thigh flap can be used to repair the whole hand degloving injury in one stage. The repair hand has basic hand function and satisfactory shape.
【學(xué)位授予單位】：揚(yáng)州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R658.2

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