吻合单根动脉指尖再植侧支回流解剖学和流体力学研究

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1、广州医学院硕士学位论文吻合单根动脉指尖再植侧支回流解剖学和流体力学研究硕士研究生：周望高导师：张振伟教授专业：外科学中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

2、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2用流体力学的伯努利定律（ρgh+½ρv+p=C）分析，这种现象是吻合单根动脉指尖再植成

3、活的主要机制。关键词：再植术；侧支；空吸现象；流体力学-1-广州医学院硕士学位论文AnatomyandfluidmechanicsanalysisofcollateralcirculationinfingertipreplantationwithsinglearteryanastomosisPostgraduate:ZHOUWang-gaoTutor:Prof.ZHANGZhen-weiProfession:surgeryAbstractObjectiveTostudytheanatomicalcharacteri

4、sticsoffingerarterialcollateralinthedistalfingersandanalysisthephenomenonoffingertipreplantationwithsingleanastomosisofcollateralreturnandinvestigatetheFluidDynamics.MethodsLatexperfusionfortenfreshcadavershandspecimen,thenumberanddiameteroffingerarterialcolla

5、teralwereobservedinthedistalfingersbymicrosurgicalanatomy.Theangleofcollateralandthebackboneofthearterywereobservedinfivefingerarterycastspecimens.Afluiddynamicsmodeloffingertipreplantationconsistentwithasinglearterywereestablishedbyasimpledevice,thephenomenon

6、ofcollateralreturnwereobserved.Eighty-fivecasesoffingertipreplantationthatsurvivedaftersinglearteryanastomosiswereinvolvedinthestudy.ResultsThenumberoffingerarterialcollateralinthedistalfingersis12.7±3.2.thediameteris0.32±0.08mm.About60.3%ofTheangleofcollatera

7、landthebackboneofthearterybetween30°～60°,thefingerarterialarchcollateralanglecloseto90°.ObservedthephenomenonofidealliquidcollateralreturnfromFluidDynamics2广州医学院硕士学位论文modeloffingertipreplantationconsistentwithasingleartery.Eighty-onecasesoftheEighty-fivereplan

8、tedfingertipssurvived,fourcaseswerelost.Theoverallsurvivalratewas95.3%.ConclusionWeshouldbekeptthefingerarterycollateralofproximalanastomotic,shortenthedistanceofthefingerarteriala