【作者】 王天亮；

【导师】 侯瑞兴；

【作者基本信息】 苏州大学 ， 骨外科学（专业学位）， 2013， 硕士

【摘要】 目的：探索治疗手指Ⅰ度脱套伤的新术式及观察其临床疗效。方法：研究包括基础研究和临床应用两部分。基础研究包括活体测量实验和尸体模型实验。活体测量：将50例成人中指中节中部以远皮肤以两侧中线为界，分为掌、背侧二部分。分别测量其长度、近端宽度和远端宽度。测量足第二趾甲背皮瓣和对侧足第二趾胫侧皮瓣的理论最大可切取范围的长度、近端宽度和远端宽度。比较背侧部分与足第二趾甲背皮瓣、掌侧部分与对侧足第二趾胫侧皮瓣的大小。尸体模型实验：制作25例尸体标本中指Ⅰ度脱套伤模型。测量掌、背侧皮肤和创面大小。计算皮瓣系数。根据皮瓣系数设计切取上述皮瓣，修复模型指，观察修复效果。临床应用15例15指，随访时间6-24个月。结果：活体测量足第二趾甲背皮瓣和对侧足第二趾胫侧皮瓣瓦合后的最大可切取范围的长度、近端宽度和远端宽度均大于中指中节中部以远皮肤的长宽。提示：上述皮瓣瓦合后能修复中指Ⅰ度脱套伤创面。测量模型指得皮瓣系数掌侧为1.5，背侧为1.3。根据皮瓣系数设计切取皮瓣修复的模型指的外形与正常指相似,临床15例15指皮瓣全部成活，经过6-24个月随访，修复指外形与正常手指类似。感觉恢复好，2-PD6-10mm。根据标准评定：优10指，良4指，可1指，优良率为93.3%。供区植皮全部成活,足部活动无影响。结论：瓦合足第二趾甲背皮瓣与对侧足第二趾胫侧皮瓣能有效修复手指Ⅰ度脱套伤。修复指外形逼真（无指腹大而垂、无颈部狭窄）。供区足趾完整。皮瓣系数为临床治疗手指脱套伤精确设计皮瓣提供了新的简化工具。更多还原

【Abstract】 Objective: To explore the new surgical treatment and curative effect forclassⅠdegloving injuries of fingers．Methods:Basic research and clinical application were needed.The former includesexperiments of living body measurement and cadaveric model.The experiment of livingbody measurement:the skin beyond the middle section of50people’s middle fingers wasdivided into dorsal part and palmar part,according to both sides of the center line. Thelength, the proximal width and the distal width of them were measured. Also,that of thewrap around flap of one second toe and the tibial flap of another second toe weremeasured,and compared with each other. The experiment of cadaveric model:25cadaversmodel of classⅠdegloving injuries of fingers were made.Measuring the size of skin andwound partly. Flap coefficient was calculated. Designing and cutting the flap according toflap coefficient,and repairing model of classⅠdegloving injury of finger, observing therepairing effects. Clinical application of15fingers of15patients were followed up for6-24months.Results： The experiment of living body measurement pointed out that thecorresponding diameter size of the wrap around flap of one second toe and the tibial flap ofanother second toe was higher than that of skin of finger. The flap coefficient of the palmarpart was1.5,and that of the dorsal part was1.3after measured.The appearance of fingermodel was similar to normal finger after repaired.Flaps of clinical application were allsurvived, After6-24months of follow-up，the repaired fingers were similar to normalfingers with Good feeling, two-point discrimination was6to10mm. According to thefunctional evaluation standard，The functional results were encouraging in all patients(10excellent,4good，and1fair),with an excellent and good rate of93.3%. Donor sites of thetoes healed well without scarring, walking completely normal. Conclusions: Using wrap around flaps of the second toe and tibial flaps of theopposite second toe to repair class I degloving Injuries of fingers is an ideal method. Flapcoefficient was a simplified new tool for the clinical treatment of class I degloving injuryof finger.更多还原