MDCTA三维重建在穿支皮瓣的可视化研究与设计

Study and Design of MDCTA Three-dimensional Reconstruction in Visualization of Perforating Branch Flap

目的探索Multidetectorrow Computer Tomographic Angiography(MDCTA,胰腺血管的多层CT血管成像)三维重建在穿支皮瓣的可视化研究与设计中的应用价值。方法纳入2016年9月—2019年8月深圳龙华区人民医院收治的拟行穿支皮瓣的24例患者为研究对象,术前均采用多普勒测量和MDCTA测量,依据MDCTA三维重建的位置及供血设计皮瓣。比较多普勒测量和MDCTA测量与术中解剖相符率并分析MDCTA扫描效果,记录本组患者穿支皮瓣一般情况和成活情况。结果本组24个皮瓣包括8例前臂骨间背侧动脉穿支皮瓣,4例旋股外侧动脉降支皮瓣,6例足第二趾穿支皮瓣,6例桡动脉掌浅支穿支皮瓣,最小面积为1cm×0.5cm,最大面积为20cm×14cm;旋转角度最小90°,最大180°。MDCTA术前定位与术中解剖相符率为100.00%,明显高于多普勒测量的75.00%(χ^2=6.857,P<0.05)。经MDCTA扫描可清晰分辨供血、位置、解剖关系。三维重建可立体清晰显示扫描部位血管与周围三维关系,且可实现任意角度的旋转观看。本组患者皮瓣Ⅰ期植皮率为91.67%,明显高于需Ⅱ期植皮率(χ^2=33.333,P<0.01)。随访见皮瓣色泽质地良好,皮瓣两点感觉>0.3cm。结论MDCTA三维重建能够直观、精确、立体定位穿支血管,显示皮瓣血流灌注范围,应用于皮瓣设计指导有利于提高手术安全性。

Objective To explore the application value of MDCTA(Multidetectorrow Computer Tomographic Angiography)threedimensional reconstruction in the visualization research and design of perforating branch flaps.Methods 24 patients with perforator flaps from September,2016 to August,2019 were enrolled in the hospital.Doppler and MDCTA measurements were used before operation.Flaps were designed according to the location and blood supply of three-dimensional reconstruction of MDCTA.The coincidence rate of Doppler and MDCTA measurements with intraoperative anatomy was compared, and the results of MDCTA scanning were analyzed.Results The 24 flaps included 8 perforating flaps of dorsal interosseous artery of forearm,4 descending branch flaps of lateral circumflex femoral artery,6 perforating flaps of second toe of foot,and 6 perforating flaps of superficial palmar branch of radial artery.The smallest area was 1 cm×0.5 cm,the largest area was 20 cm×14 cm,and the smallest rotation angle was 90 degrees and the largest 180 degrees.The coincidence rate between preoperative localization and intraoperative anatomy of MDCTA was 100.00%, which was significantly higher than 75.00% of Doppler measurements(χ^2=6.857,P<0.05).The blood supply,location and anatomical relationship could be clearly distinguished by MDCTA scan.Three-dimensional reconstruction could clearly display the three-dimensional relationship between the blood vessels and the surrounding areas,and could realize rotation viewing at any angle.The skin graft rate of stage Ⅰ was 91.67% in this group,which was significantly higher than that of stage Ⅱ(χ^2=33.333,P<0.01).Follow-up showed that the color and texture of the flaps were good,and the two-point sensation of the flaps was more than 0.3 cm.Conclusion Three-dimensional reconstruction of MDCTA can visually, accurately and stereotaxically locate perforator vessels and display the blood perfusion range of skin flaps.It is helpful to improve the safety of operation when it is applied to the design and guidance of skin flaps.