增强现实技术联合多普勒超声在胫后动脉穿支皮瓣修复踝周软组织缺损的应用

Augmented reality technology combined with Doppler ultrasound in repair of soft tissue defect around ankle with posterior tibial artery perforator flap

目的探讨增强现实(AR)技术联合多普勒超声在胫后动脉穿支皮瓣修复踝周软组织缺损中的临床应用价值。方法2017年6月至2020年6月,对足踝部周围不同程度软组织缺损13例患者应用胫后动脉穿支皮瓣进行修复,缺损面积3.0 cm×7.0 cm-5.0 cm×10.0 cm。术前皮瓣供区CTA扫描,获得皮瓣供区动脉血供三维图像。明确胫后动脉穿支皮瓣血供的起源、走向、血管蒂长度、管径以及穿支点位置。应用基于安卓手机的图像融合软件实现AR技术导航标记血管走行及穿出点体表位置,同时采用多普勒超声对导航的定位结果进行确认,以最佳穿支点作为皮瓣旋转点进行皮瓣设计后进行皮瓣切取和创面修复,术后门诊随访评估近、远期皮瓣成活情况及踝关节功能。结果13例皮瓣全部成活,均无血管危象发生。术后经6-16(平均10)个月的随访,皮瓣质地柔软、血运良好,修复部位色泽与正常皮肤基本一致;踝关节功能按美国矫形外科足踝协会(AOFAS)评分标准评定:优9例,良4例;供区无明显瘢痕形成。结论AR技术联合多普勒超声应用于胫后动脉穿支皮瓣手术规划的方法具有操作简单、实用的优点,能够降低手术风险,具有临床实用意义。

Objective To investigate the clinical value of augmented reality(AR)technology combined with Doppler ultrasound in repairing soft tissue defects around ankle with posterior tibial artery perforator flap.Methods From June,2017 to June,2020,13 patients with soft tissue defects around ankle were repaired with the posterior tibial artery perforator flap sized 3.0 cm×7.0 cm-5.0 cm×10.0 cm.Preoperative CTA scan was performed to obtain the 3-dimensional image of the blood supply of the donor site.The origin and direction of blood supply,length of pedicle,diameter and the location of perforator were determined.An image fusion software based on Android mobile phone was used from the body surface to realize the navigation by AR,and to mark the locations of the points where blood vessels ran and passed by.At the same time,Doppler ultrasound was employed to confirm the navigation.The optimal puncture fulcrum was used as the flap rotation point in design of the flap.After the flap had been designed,the flap was harvested and the defect was repaired.Outpatient clinic follow-up was performed to evaluate the survival of flap and the function of ankle.Results All 13 flaps survied without vascular issues.After 6-16(average 10)months follow-up,all flaps survived.The flaps appeared soft with good blood supply.The colour of the repaired sites were basically the same as normal skin.According to American Orthopedic Foot and Ankle Society(AOFAS),the ankle function was excellent in 9 patients and good in 4 patients.There was no obvious scar formation on the donor sites.Conclusion The application of AR technology combined with Doppler ultrasound in the surgical planning of posterior tibial artery perforator flap has advantages in easy to operate in clinical practice.It can reduce the risk of surgery,and has significance in clinical practice.