CT血管成像和彩色多普勒超声在腓动脉穿支皮瓣术前穿支评估的对比研究

Preoperative vascular evaluation of perforator flap of peroneal artery: A comparative study between CT angiography and colour Doppler ultrasound

目的对比研究CTA和CDU在腓动脉穿支皮瓣移植中的应用。方法回顾性分析自2013年2月-2016年10月中国人民解放军联勤保障部队第920医院骨科使用腓动脉穿支皮瓣修复重建软组织缺损的47例患者完整资料,术前均行CTA及CDU检查,选取合适的穿支血管并记录其体表定位点和外口径,与术中实际观察、测量值进行比较,数据分析使用SPSS 22.0统计软件,P<0.05为差异有统计学意义。结果CDU检测术中拟用穿支位置符合率为97.87%,CTA检测术中拟用穿支位置符合率为95.74%,两组之间比较差异无统计学意义(P>0.05)。穿支血管外直径术前CTA与CDU测量值与术中实际测量值相一致,两组比较差异无统计学意义(P>0.05),CTA联合应用CDU定位的腓动脉穿支血管,术中探查血管位置符合率为100%。术后皮瓣均获随访,随访时间为1~18个月,平均13.5个月。所有皮瓣均成活良好,无其他并发症,皮瓣质地优良,外形美观。结论CDU和CTA在腓动脉穿支皮瓣术前血管评估方面是一种可靠且有用的方法,且临床上可互补联合应用。

Objective To compare the clinical value of CTA and CDU in perforator flap of peroneal artery.Methods From February 2013 to October 2016,47 patients who suffered with soft tissue defects and were hospitalised in the Department of Orthopaedics,the 920th Hospital of Joint Logistic Support Force of Chinese PLA were retrospectively reviewed and evaluated.All the defects were reconstructed by the perforator flap of peroneal artery.All patients received preoperative CTA and CDU scans before surgery.Appropriate perforator vessels were selected and the locating points in body surface and external diameters of the perforator vessels were recorded and compared with intraoperative findings.SPSS 22.0 statistical software was used for data analysis.P<0.05 was considered statistically significant.Results The intraoperative coincidence rate of the proposed perforator vessels was 97.87%for CDU and 95.74%for CTA,with no significant difference between the 2 groups(P>0.05).It was found that the preoperative CTA and CDU measurements were consistent with the actual intraoperative measurements,and there was no significant difference between the 2 groups(P>0.05).For CTA combined with CDU,an intraoperative coincidence rate was 100%in the location of peroneal perforating vessels.All flaps were followed-up for 1 to 18(mean 13.5)months.All the flaps survived well with good texture and appearance without complication.Conclusion CDU and CTA are reliable and useful in preoperative vascular evaluation of peroneal perforator flap,and both can be used in a complementary or combined manner.