高频彩色多普勒超声在游离股前外侧穿支皮瓣中血管皮支定位的应用研究

Study of the application of high frequency color Doppler in skin branch blood vessel positioning in dissociative anterolateral thigh flap

目的利用高频彩色多普勒超声技术研究股前外侧穿支皮瓣穿支分布规律、体表的定位及血流动力学,评估高频彩色多普勒超声检测的准确性,为术前供区选择双侧中的优势侧提供参考依据。方法运用高频彩超对30例健康志愿者及13例股前外侧穿支皮瓣手术患者的双侧穿支血管数目、管径、起点位置、走行位置、穿深筋膜位置、平均流速进行检测,并与术中观察到的穿支血管数据及Dopplar超声探测数据进行对比,并做统计学分析。结果 30例健康人及13例患者共检测到穿支动脉192条,其中肌皮穿支型占79.3%;肌间隙皮支型18.6%,直接皮血管型2.1%。穿支管径(外径)(1.02±0.41)mm;平均血流速度左右侧差异无统计学意义(P>0.05),男性稍高于女性(P<0.05)。Dopplar超声与彩色多普勒超声、术中比较,差异有统计学意义(P<0.05)。彩色多普勒超声与术中比较,差异无统计学意义(P>0.05)。频谱显示:收缩期正向波,舒张期流速极低或没有血流,呈低速高阻单相频谱。结论高频彩色多普勒超声可以直观地观察到旋股外侧动脉、旋股外侧动脉降支及较粗大穿支的数量、管径、管壁结构、走行方向、分布区域、血流动力学性状,评价血管质量以及进行体表定位。13例手术患者中检测到的穿支结果与手术中所见的穿支数量、位置、管径基本吻合。高频彩色多普勒超声可以较精确地了解股前外侧穿支皮瓣供区血管穿支的情况,为临床选择优势侧皮瓣供区提供了较直观的依据。

Objective To study the distribution pattern of the perforating blood vessels, body surface positioning and haemodynamics in dissociative anterolateral thigh flap （ALTF） by making use of high frequency color Doppler technology, which will provide the reference evidence in selecting the advantage side between the two donor sides prior to surgery. Methods To test the number, caliber, starting point, traveling course, location passing through the deep fascia, mean flow rate of two-side ALFT perforating blood vessels on 30 healthy volunteers and 13 cases of surgical patients by high frequency color Doppler, and by making the comparison of the observation of perforating blood vessels during the surgery with that detected by color Doppler, statistic analysis had been conducted. Results All together 192 perforating arteries had been detected among 30 healthy people and 13 cases of patients, and among which 79.3% were myocutaneous perforator, 18.6% were septocutaneous perforator and 2.1% were direct cutaneous perforator. Perforating caliber was （1.02±0.41）mm;There was no statistic significance between left side and right side in mean flow rate of blood（P〉0.05）, but there was statistic significance between males and females, with higher mean flow rate among males than females（P〈0.05）. There was no statistic significance between color Doppler findings and surgical observations（P〉0.05）. Frequency spectrum demonstration：forward wave in contraction period, extreme slow flow rate or without blood flow in diastole period with low speed and high resistance one-way spectrum. Conclusions High frequency color Doppler can directly observe lateral femoral circumflex artery, the descending branch of the lateral circumflex femoral artery, as well as the characters of bigger perforating blood vessels in terms of number, caliber, structure of blood vessel wall, extending direction, distribution area, haemodynamics, blood vessel quality evaluation and body surface positioning. The perforating results in 13 cases of patients observed during surgeries are consistent with the detection by Doppler from perspective of perforating numbers, location and caliber. High frequency color Doppler provides direct evidence for clinical selection in advantage side of skin flap by precisely obtaining the information of perforating blood vessels at the ALTP donor site.