数字化组织瓣的虚拟临床解剖学测量

Virtual clinical anatomy measurement of digital tissue flap

背景:近年来,数字化技术已成为骨科、显微外科学界的研究热点和前沿课题,其在骨关节数字化模型建立、虚拟手术系统研发以及临床应用等领域均取得令人瞩目的成果。与传统方法相比较,数字化虚拟技术的应用能够建立更为直观、立体,可供个体操作的三维组织瓣模型,可望提供更为精确、详实的解剖学数据,并可为临床应用提供参考依据。目的:探讨数字化三维重建组织瓣模型进行虚拟解剖学测量的应用价值。方法:①取新鲜捐献成人尸体标本2具,采用改良的明胶-氧化铅灌注术经腹主动脉灌注,灌注后对肢体行连续螺旋CT扫描。②健康成人志愿者6人,经肘静脉注射造影剂,使用64排多层螺旋CT进行扫描。将这两种方法采集的数据以Dicom 格式输入计算机,应用 Amira4.1 软件进行腓肠肌皮瓣和髂骨瓣的三维重建并立体显示,观察并测量记录组织瓣的主要供血动脉类型,血管穿支数目,主支和穿支血管的外径、管蒂长度和分布情况,并与尸体标本解剖的组织瓣数据进行比较。结果:数字化三维重建组织瓣模型测量数据与尸体标本组织瓣的解剖学数据基本相符。氧化铅灌注数据重建模型更能清楚地显示细小穿支血管及血管网分布,但由于灌注压影响,重建的血管外径大于正常血管外径范围,而CT血管造影数据重建的血管外径在正常血管外径范围内,且均偏小。结论:采用数字化三维重建技术可直观显示正常组织瓣的三维解剖形态,可丰富显微外科临床与解剖的教学手段,解决尸体解剖教学标本不足的问题,并为今后大体解剖学测量提供新思路。

Background： In recent years, digital technology has become one of the hottest and most advanced topics in the field of ortho- pedic surgery and microsurgery, which have achieved remarkable progress in reconstructing the digital model of the bone and joint and developing virtual surgery system. For example, a three-dimensional tissue flap model could be established us-ing digital virtual technology, which, compared with traditional methods, gives a more intuitive and personalized view for the surgeons. Therefore, it is expected to provide more accurate and detailed anatomical data for clinical studies. Objective： To evaluate the application of digital three-dimensional tissue flap in anatomic measurement. Methods： Six adult volunteers underwent contrast-enhanced CT angiography of pelvic and lower limbs by a 64-row multi-slice spiral CT after median cubital vein injection with Ultravist （3.5 ml/s）. Two-D images from these data in Dicom format were transformed into computer. Two adult fresh cadaver specimens, one male and one female, were subjected to ra-diographic CT scanning before and after perfused with lead oxide-gelatine mixture, with collimation of 0.5 mm. Through Amira 4.1 （TGS） software, the 2-D images in Dicom format were transformed into the 3-D models of the entire region. Ami-ra 4.1 Was used for 3-D reconstruction and 3-D display of gastrocnemius flap and iliac bone flap to observe the main flap ar-tery type, the number of perforator vessels, the diameter of the main and perforator vessels, the tube pedicle length and dis-tribution of anatomical specimens compared with the tissue flap data. Results： The data of the digital flap model complied with that of the skin specimens. The small perforator vessels and the distribution of vascular network could be clearly observed in the model perfused with lead oxide-gelatine mixture. The diam-eter of blood vessel was larger than the normal one due to the perfusion pressure in the reconstruction model. However, the diameter was smaller by CT angiographic reconstruction.