摘要
目的探讨CT血管造影(CTA)检查结合三维重建辅助设计腓浅动脉穿支皮瓣修复手部创面的疗效。方法采用回顾性病例系列研究分析2016年1月至2019年12月解放军联勤保障部队第九二〇医院收治的15例手外伤患者临床资料,其中男11例,女4例;年龄19〜51岁[(27.8±8.1)岁]。患者均为手部软组织缺损合并骨骼或肌腱外露,缺损范围2.0 cm×1.O cm〜6.0 cm ×4.0 cm。患者术前均行腹主动脉至足背动脉CTA检查,并使用Mimics 20.0软件三维重建下肢骨骼、血管、皮肤等组织,精确测量腓浅动脉穿支血管定位点、血管直径及血管长度,然后根据创面大小和形状设计皮瓣,并使用软件模拟皮瓣切取操作术中按设计切取腓浅动脉穿支皮瓣并移植修复创面:术中测量穿支血管定位点、直径和长度等指标,并与术前建模测量进行比较。记录手术时间和术中出血量。术后观察皮瓣存活及供区愈合情况。术前及术后3个月,按照中华医学会上肢功能评定标准评价患肢功能。术后3个月,观察供区外观、感觉和活动情况。结果基于重建的三维模型,可在术前明确腓浅动脉穿支来源及走行,建模所得穿支血管定位点、直径和长度与术中实际测量结果差异均无统计学意义(P>0.05)。患者均获随访6〜20个月[(12.2±3.8)个月]。手术时间为50〜125 min[(91.2±10.4)min],术中出血量为150〜450 ml[(364.1±44.7)ml]。术后2例皮瓣出现部分表皮坏死,换药后逐渐愈合,其余皮瓣均顺利成活。供区均可直接缝合,切口均Ⅰ期愈合。术后3个月,中华医学会上肢功能评定标准评分为(76.4±9.7)分,高于术前的(48.2±10.1)分(P<0.05),其中优8例,良6例,可1例,优良率为93%。术后3个月,所有患者供区轻微瘢痕生长,足背及供区皮肤感觉无明显异常,行走步态正常。结论CTA检查结合Mimics软件7维重建可精确定位穿支血管,实现腓浅动脉穿支皮瓣的个体化、精准化设计,辅助快速准确切取皮瓣,从而促进手部创面愈合及功能恢复。
Objective To investigate the effectiveness of CT angiography(CTA)combined with three-dimensional modeling-assisted design of superficial peroneal artery perforator flap for reconstmction of traumatic hand wound.Methods A retrospective case series study was conducted to analyze the clinical data of 15 patients with hand injury admitted to 920th Hospital of Joint Logistic Support Force of PLA from January 2016 to December 2019.There were 11 males and 4 females,aged 19-51 years[(27.8±8.1)years].All patients had soft tissue defect of the hand with exposed hone or tendon,and the defect area ranged from 2.0 cm × 1.0 cm to 6.0 cm × 4.0 cm.All patients underwent CTA of the abdominal aorta to dorsalis pedis artery before surgeiy.The three-dimensional models of bones,blood vessels,skin and other tissues were reconstructed by Mimics 20.0 software.The location,diameter and length of the superficial peroneal arteiy perforator vessels were accurately measured,and the perforator flap was designed according to the shape and size of the defect,then the resection of flap was simulated.During the operation,the supeificial peroneal ailerv perforator flap was removed and transplanted to repair the defect according to the design.The location,diameter and length of perforator vessels were measured intraoperatively and compared with the preoperative modeling measurement.The operation time and intraoperative blood loss were recorded.The survival of the flap and healing of the donor site were observed after operation.The function of the affected limb was evaluated according to the upper limb function evaluation standard of Chinese Medical Association before and 3 months after surgery.The appearance,sensation and motion of the donor site were observed 3 months after surgery.Results The origin and course of superficial peroneal artery perforator vessels could be clarified preoperatively based on the three-dimensional model.There was no significant difference in the location,diameter and length of perforator vessels between the pre-and intra-operative measurements(P>0.05).All patients were followed up for 6-20 months[(12.2±3.8)months].The operation duration was 50-125 minutes[(91.2±10.4)minutes],with blood loss of 150-450 ml[(364.1±44.7)ml].The partial epidermal necrosis occurred in 2 patients after surgery,which gradually healed after dressing change,and other flaps survived smoothly.All donor sites could be sutured directly,and all incisions healed by first intention.According to the upper limb function evaluation standard of the Chinese Medical Association,the affected limb scored(76.4±9.7)points 3 months after surgery,higher than the preoperative score of(48.2±10.1)points(P<0.05).The results were excellent in 8 patients,good in 6 and fair in 1,with the excellent and good rate of 93%.All patients had slight scar gi'owth in donor sites and showed no obvious abnormalities in the sensation of foot dorsum and donor sites,with normal walking gait.Conclusion CT angiography combined with three-dimensional modeling can accurately locate the perforating vessels,realize the individualized and precise design of the superficial peroneal artery perforator flap,and assist in the rapid and accurate flap resection,and hence promote wound healing and functional recovery of the hand.
作者
石岩
何晓清
杨曦
王腾
崔轶
刘武华
徐永清
Shi Yan;He Xiaoqing;Yang Xi;Wang Teng;Cui Yi;Liu Wuhua;Xu Yongqing(Department of Orthopedic Surgery,920th Hospital of Joint Logistic Support Force of PLA,Kunming 650032,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2021年第6期501-507,共7页
Chinese Journal of Trauma
基金
云南省卫健委临床中心建设重大项目(ZX20191001)
解放军联勤保障部队第九二〇医院院内科技计划资助项目(2020YGC02)。
关键词
手损伤
血管造影术
图像处理
计算机辅助
穿支皮瓣
Hand injuries
Angiography
Image processing,computer-assisted
Perforator flap
