腓骨肌皮瓣穿支血管定位导板的临床应用

Clinical application of perforator vessel location guide plate for fibular musculocutaneous flaps

目的 探讨3D打印固定式定位导板在腓骨肌皮瓣穿支血管的精准定位方法并评价其应用效果。方法 本研究已通过单位伦理委员会审查批准,并获得患者知情同意。选取2019年5月至2022年10月就诊于新疆医科大学第一附属医院口腔颌面外科由于颌骨缺损需行腓骨肌穿支皮瓣游离移植修复的患者14例。导板组(7例)采用CTA结合Mimics软件三维重建患者双下肢并定位穿支血管位置,数字化设计腓骨肌皮瓣穿支血管定位导板,将导板的两端设计为固定端,上方一端固定于膝关节,下方一端固定于踝关节,3D打印完成导板;对照组(7例)采用常规手持式多普勒进行术前定位。比较两组皮瓣制取时间、术中出血量、住院时间、定位穿支血管的差异、术后并发症出现情况、术后供区外形满意度及下肢功能评定量表(lower extremity functional scale,LEFS)。采用SPSS 25.0软件包对数据进行统计学分析。结果 导板组的制取皮瓣时间、术中出血量、住院时间、穿支血管定位及术后供区外形满意度均优于对照组,差异有统计学意义(P<0.05),术后皮瓣并发症、LEFS评分差异无统计学意义(P>0.05)。结论 基于3D打印技术的腓骨肌皮瓣穿支血管固定式定位导板的定位准确性更好,采用膝关节和踝关节固定点,能更有效地稳定导板位置,避免软组织偏移,提高了定位精准度,值得临床推广。

Objective Based on 3D printing technology,explore the precision of a perforator vessel location guide plate for fibular musculocutaneous flaps before the transplantation of fibular osteocutaneous flaps and evaluate its appli-cation effects.Methods This study was reviewed and approved by the ethics committee,and informed consent was obtained from the patients.From May 2019 to October 2022,14 patients with jaw defects who needed to undergo fibular perforator flap transplantation at the First Affiliated Hospital of Xinjiang Medical University were selected.For the sev-en patients in the guide plate group,CTA was combined with Mimics software to reconstruct both lower limbs,and the perforator vessel positioning guide for locating perforator vessels was designed;the two ends of the guide plate were de-signed as fixed ends,with the upper end fixed to the knee joint and the lower end fixed to the ankle joint,and the guide plate was fabricated by a 3D printer.For the seven patients in the control group,a conventional handheld Doppler probe was used for perforator vessel location.The average operation time,bleeding volume,recovery time,deviation of perfora-tor vessel location,postoperative flap-related complications,postoperative donor site shape satisfaction,and lower ex-tremity functional scale(LEFS)score were recorded.SPSS 25.0 software was used for statistical analysis.Results The average operation time,bleeding volume,recovery time,deviation of perforator vessel location and postoperative donor site shape satisfaction were significantly better in the guide plate group than in the control group(P<0.05);moreover,the differences in postoperative flap-related complications and LEFS scores were not statistically significant(P>0.05).Conclusion Based on 3D printing technology,fibular musculocutaneous flap perforator vessels can be more accurately located using a guide plate and the knee and ankle as fixed points,and this method can effectively stabilize the guide position,prevent soft tissue offset,and improve positioning accuracy and thus deserves to be generalized.