混合现实技术在股前外侧皮瓣修复四肢软组织缺损中的临床应用

Application of mixed reality technology in reconstruction of soft tissue defect in extremities with anterolateral thigh flap

目的探讨混合现实(MR)技术在游离股前外侧皮瓣(ALTF)移植修复四肢软组织缺损中的应用价值。方法2019年12月-2021年11月,回顾性分析云南省第一人民医院骨科采用ALTF修复四肢软组织缺损并获随访的患者10例,其中手部4例,足踝部6例。急诊入院6例,受伤至入院时间为4.0~15.0 h,平均7.3 h;慢性感染及溃疡导致软组织缺损4例,入院后给予清创,软组织缺损二期行皮瓣转移。缺损面积8.0 cm×5.0 cm~22.0 cm×8.0 cm。术前基于下肢CTA数据,建立3D骨-血管-皮瓣模型,术中利用MR技术将3D模型投照于皮瓣供区,实时观察虚拟血管走行,定位穿支点,并观察虚拟图像和术中实际解剖所得穿支定位、走行的符合情况。末次门诊随访时记录皮瓣的外形、质地、颜色等,根据关节总的活动度(TAM)评分评价手功能,根据美国矫形足踝外科协会(AOFAS)评分评价足踝部功能。结果所有患者术前均成功重建出穿支血管的位置及走行,术中应用MR技术定位穿支、虚拟穿支走行与实际解剖一致,匹配度达100%。术前测量血管蒂长为(11.02±1.37)cm,术中测量为(11.21±1.23)cm,两者相比较(P=0.748,t=-0.326),差异无统计学意义(P>0.05)。皮瓣面积为9.0 cm×6.0 cm~23.0 cm×9.0 cm,供区均一期闭合。患者均获随访,时间为1~24个月,平均13.5个月。术后皮瓣均成活,皮瓣外形、颜色、质地良好,供区仅留1条线形瘢痕,手部功能根据TAM评分,优3例,可1例;足踝部功能根据AOFAS评分,优5例,良1例。结论MR技术应用于ALTF可以实时定位皮瓣血管走行,指导手术操作,提高手术效率,降低手术风险。

Objective To investigate the application value of mixed reality(MR)technology in reconstruction of soft tissue defect of extremities with free anterolateral thigh flap(ALTF).Methods From December 2019 to November 2021,a retrospective analysis was performed on 10 patients who had undergone ALTF reconstruction of soft tissue defects in extremities in Department of Orthopaedics,the First People's Hospital of Yunnan Province.Four patients had the defects in hand and 6 patients in foot and ankle.For the 6 patients in emergency surgery,the time from injury to admission was 4.0-15.0 hours,with an average of 7.3 hours.Four patients with soft tissue defects caused by chronic infection and ulcers were given debridement,and the soft tissue defects were reconstructed by flap transfer at the second stage.The defect area were from 8.0 cm×5.0 cm to 22.0 cm×8.0 cm.Preoperatively,3D bone-vessel-flap model was established based on the lower extremity CTA scans.Intraoperatively,MR technology was used to project the 3D model on the flap donor site to observe the virtual profile of vessel shape in real time,to locate the perforator and the course of the perforator,and observe the consistency between the virtual image and the actual anatomy of the perforator.The appearance,texture and colour of the flap were recorded at the last follow-up.Hand function was evaluated by the total activity movement(TAM),and foot and ankle function was evaluated by the American Orthopaedic Foot and Ankle Society(AOFAS).Results The position location and course of perforator vessels were reconstructed successfully in all patients before surgery.The MR technology was used to locate the perforator,and the course of the virtual perforator was consistent with the actual anatomy,and the matching reached 100%.The length of vascular pedicle measured before surgery was at 11.02 cm±1.37 cm.And that measured during surgery was at 11.21 cm±1.23 cm(P=0.748,t=-0.326).The difference was not statistically significant(P>0.05).The flap area was at 9.0 cm×6.0 cm to 23.0 cm×9.0 cm.The donor site was sutured directly in one stage.All patients were entered postoperative followed-up for 1 to 24 months,with an average of 13.5 months.All the flaps survived after surgery.The flap with good appearance,colour and texture,and only one linear scar was left in the donor site.According to the TAM of the hand function,3 cases were excellent and 1 was fair.Foot and ankle function were evaluated according to the AOFAS,5 cases were in excellent and 1 was good.Conclusion MR technology applied to the surgery of ALTF can locate the course of the flap vessels in real time,guide the operation,improve the operation efficiency and reduce the risk in surgery.