牵拉性撕脱伤对动脉闭塞率的影响

潘宝华　李荟元　鲁开化等

(1.第四军医大学西京医院整形外科中心西安7100322.近畿大学医学部形成外科,日本大阪)

潘宝华,1963年生,1987年第四军医大学医疗系毕业,现任第四军医大学西京医院整形外科中心主治医师,医学博士,发表论文7篇,参编整形美容专著3部。[摘要]目的:研究在牵拉性撕脱损伤时动脉内膜的变化及其闭塞率。方法:建立大白鼠动脉牵拉性撕脱伤模型,给予60～140g牵拉力,观察其内膜形态变化。结果:随牵拉力的增加,闭塞率逐渐增大,至140g时达到100%。形态观察可分为:①内膜断裂型;②内膜瓣状型二个类型。牵拉损伤的动脉切断后原位显微吻合的成功率为83.33%。结论:损伤动脉有特征性的内膜变化,瓣状型内膜损伤可导致血栓形成,影响显微外科的成功率。

[关键词]牵拉性撕脱伤动脉内膜闭塞率

[中图分类号]R616.2[文献标识码]A[文章编号]1008-6455(2000)05-0328-04

THE EFFECT OF DISTRACTION AVULSION INJURY ON

ARTERIAL OCCLUSION RATE

PAN Bao-HuaLI Hui-YuanLU Kai-Hua et al

Depatment of Plastic Surgery,Xijing Hospital,The Fourth Military

Medical University,Xi竌n,710032

[Abstract]Objective:To investigate the morphological changes and occlusion rate of post-avulsion injury artery.Methods:Rat model for arterial avulsion injury was developed.Distraction force of 60-140g was applied separately.The morphological changes of arterial endometrium were observed.Result:With the increasing of distraction forec,the occlusion rate was increased accordingly.When the distraction force increased up to 140g,the occlusion rate was 100%.The morphological changes could be divided into 2 main types:1.Endometrium rupture and 2.Endometrium valve formation.The injured artery was divided and anastomosed in situ,the patency rate was 83.33%.Conclusion:〖WT5"BZ〗There were typical endometrium changes after artery injury.Endometium valve formation leaded to thrombosis and further compromised the success of microsurgery.

[Key words]Distraction avulsion injuryArteryEndometriumOcclusion rate

1877年俄国Eck创立了血管吻合术^[1],成为血管修复史的一个里程碑。血管吻合方法^[2]、手术器材的更新及其抗凝剂、血管扩张剂、抗生素的出现和应用,使血管吻合后的栓塞率大幅下降^[3,4]许多有严重损伤的病例救治成功,也为美容医学尤其是美容外科的发展提供了又一途径。但比起其它的损伤因素所致的断指来说,有牵拉性撕脱损伤的病例其再植成功率相对要低^[5]。动脉血栓的发生率,在牵拉损伤时明显高于其它损伤机制^[6]。有撕脱伤的皮瓣,发生坏死的可能性也高于其它的损伤。ノ颐抢用血管损伤模型,探讨牵拉性撕脱损伤对动脉内膜的影响及其血管栓塞率的关系,为显微外科、整形美容外科临床提供理论依据。……