术前CT血管成像在股前外侧穿支皮瓣移植中的临床应用

Clinical application of preoperative CT angiography in anterolateral thigh perforator flap transplantation

目的探讨术前CTA在股前外侧穿支皮瓣移植中的准确性和实用性。方法15例行股前外侧穿支皮瓣移植患者，术前行CTA检查，分析穿支动脉走行情况，对穿支动脉参数进行测量，选出最适合的穿支用于手术，观察并测量术中穿支相关参数与影像测量进行对照。采用配对t检验对比CTA与术中测量穿支的直径和起始位置距离的差异。结果15例患者中，1例CTA和术中均未发现符合要求的穿支，后转用腹壁皮瓣移植。14例患者CTA设计的穿支动脉的直径和起始位置（垂直距离和水平距离）影像测量值与术中测量值差异无统计学意义（P〉0．05）；穿支类型与术中发现一致，肌间隙型4例，肌皮支型10例。CTA显示穿支的准确性为100％。15例患者的移植皮瓣均存活，供区无坏死。结论在股前外侧穿支皮瓣移植术中，术前CTA能准确提供穿支动脉的直径、类型和起始位置方面的信息，是一种准确、实用的方法，可提高皮瓣移植手术的成功率和安全性。

Objective To investigate the accuracy and utility of preoperative CTA in the anterolateral thigh perforator flap （ALTPF） transplantation. Methods Preoperative CTA was performed in 15 consecutive patients, who underwent the ALTPF transplantation. The suitable perforators were found through measuring and estimating the perforator parameters including size, course and origin location by reviewing preoperative angiogram. These parameters were compared with the actual intraoperative findings. Results One patient was transferred to abdominal flap transplantation, because no perforator could be found by both CTA and intraoperative observation. In 14 patients, the sizes and origin locations （ perpendicular and horizontal length from the origin of the perforator to both patella and lateral of thigh ） of all selected perforators on CTA were no significantly different from the operative findings （P 〉 0. 05 ）, and the types were consistent with the operative findings. The rate of septocutaneous perforator was 28.6% （4/14）, and the rate of musculocutaneous perforator was 71.4% （10/14）. The utilization rate of perforator flap was 93.3% （14/15）, and the accuracy of preoperative CTA was 100%. All of these ALTP flaps survived, and there was no donor site morbidity. Conclusions Preoperative mapping using CTA provides fairly accurate information about the size, type （course） and location of the perforators. Preoperative CTA in the ALTPF transplantation is an accurate and useful method and leads to safer and successful operation with optimal outcome.