第一跖背动脉CT三维重建在拇指再造术中的应用

Application of three-dimensional reconstruction images of the first metatarsal dorsal artery CT in thumb reconstruction

目的探讨第一跖背动脉cT三维重建在拇指再造术中的应用价值。方法自2008年8月至2011年3月，共收治56例患者进行拇指再造手术，其中男37例，女19例。年龄18～45岁，平均26．5岁。均为拇指损伤，术前对第一跖背动脉应用64排螺旋cT扫描，并进行三维重建。根据术前cT三维重建的图像制定相应的手术方案，用蹰甲瓣、腮甲骨皮瓣修复或游离第二足趾移植。术中显露足背动脉、第一跖背动脉。依第一跖背动脉Gilbert的分型分为3型，重点观察第一跖背动脉的走行及与第一背侧骨间肌的关系，并与术前CT三维重建的图像作相应的比较分析，观察其相符程度。结果术前行cT三维重建，第一跖背动脉I型30例，Ⅱ型21例，Ⅲ型4例，足背动脉缺如1例；术中所见与术前cT检查结果完全一致。术后56例再造手指全部成活，其中二期整形术者6例，术后随访16个月至4年，再造的拇指外观恢复较满意，指腹两点辨别觉达到5—8mm。再造的拇指恢复了抓、捏、握的功能。结论应用cT三维重建第一跖背动脉直观、可靠，为拇指再造术前手术方案的设计及术中处理血管变异情况提供可靠依据。尤其适用于第一跖背动脉手触摸不清、多普勒血流仪及彩色多普勒超声探测不清的患者。

Objective To investigate the application of three-dimensional reconstruction images of the first metatarsal dorsal CT in thumb reconstruction. Methods From August 2008 to March 2011, fifty-six patients were applied thumb reconstruction. There were 3 males and 19 females, with average age of 26. 5 years（ range from 18 to 45 years）. The injured thumbs were reconstructed by using the combined great toe-nail flap, the great toe-nail phalanx flap or second toe transplantation. All patients received the 64 row helical CT scanning in order to carry out 3-D reconstruction image before the operation. According to the CT three-dimensional reconstruction images of the first metatarsal dorsal artery, designed the operation scheme. During the operation, the dorsalis pedis artery and the first dorsal metatarsal artery were exposed. The first dorsal metatarsal artery were classified into three types according to the classification of Gilbert. The route of first dorsal metatarsal artery and the relative relationship between the first dorsal metatarsal artery and the first dorsal interosseous muscle were observed. The coincidence degree was determined between the intraoperative findings and the preoperative CT examination results. Results There were 30 cases whose first dorsal metatarsal artery were Gilbert type I, tuentyone cases in type ]I, four cases in type I]I and 1 cases with variation of dorsalis pedis artery. Intraoperative findings and preoperative CT examination results were completely consistent. All of the 56 fingers survived completely, and 6 fingers underwent second-stage plastic surgeries. Followed- up 16 months to 4 years after surgery, all the reconstructed fingers had realistic configurations, and the two-point discrimination of the finger pulps ranges from 5 mm to 8 mm. The functions such as grabbing, grasping, nipping were restored. Conclusion 3D CT images of the first dorsal metatarsal artery is intuitive and reliable. It can provide an anatomical evidence for the design of operation on reconstruction of thumb and assist to get the situation of which artery of the foot is variable. This is especially applicable to the patients whose pulse of the first dorsal metatarsal artery can not be felt with fingers or can not be detected by Doppler flowmetry and Color Doppler ultrasound.