CT血管造影辅助下先天性并指术前血管评估

Pre-operative CT angiography-guided analysis of vascular distribution in congenital syndactyly

目的应用CT血管造影技术观察不同分型的先天性并指畸形指掌侧固有动脉走行规律，并分析其对手术的指导意义。方法2012年1月至2016年5月收治先天性并指畸形患者67例，包括单纯型、复合型和综合征型，综合征型主要是Poland综合征的短指并指畸形。男43例，女24例，平均年龄2岁3个月。术前对手部行低辐射剂量CT血管造影扫描，以迭代重建算法得到图像并行三维重建，分析不同分型并指血管走行规律。结果单纯型并指33例48对，并指间指掌侧固有动脉走行及粗细均大致正常，由指掌侧总动脉分支为指掌侧固有动脉的血管分叉处轻度升高者9对（18．8％），高度位于近节指骨近1／3处；复合型并指7例11对，4对为1条指掌侧固有动脉，走行在并指中间，4对为2条动脉均存在，但直径明显小于正常血管。Poland综合征共25例66对并指，未发现并指间指掌侧固有动脉缺失，管径比健侧手的动脉偏小，均走行于指掌侧两边，发病率最高的Ⅲ型中由指掌侧总动脉分支为固有动脉的分又处轻度升高者15对（26．3％），重度升高者9对，占15．8％。结论单纯型并指可以不进行术前血管评估；Ⅲ型、Ⅳ型Poland综合征以及复合型并指术前应该行cT血管造影，以了解指掌侧固有动脉的分布、走行，防止术中损伤血管，并指导手术将动脉合理分配到相应手指。

Objective To analyze the vascular distribution of palmar digital arteries in congenital syndactyly through CT angiography and its significance for operation design. Methods From January 2012 to May 2016, 67 cases with congenital syndactyly were divided into simple, complex and syndrome type （Poland syndrome）. Preoperative angiography was performed to reconstruct 3-D distribution of digital arteries. Results 33 cases with 48 pairs simple syndactyly had relatively normal distribution and diameter of digital arteries, but the 7 case with 11 pairs complex syndactyly had only one pahnar digital artery in 4 pairs, and two arteries in 4 pairs with decreased arteries diameter. 25 cases with Poland syndrome and 66 pairs of snydaetyly had normal distribution of digital arteries with relatively small diameter. Conclusions Angiography is not necessary for simple type syndactyly, but should be performed in patients with III and IV Poland syndrome and complex type to analyze the vascular distribution within the syndactyly and give help for operative design.