腓动脉主穿支彩超定位对穿支腓肠神经营养血管皮瓣的临床意义  

Study of distribution of dominant perforators arising from peroneal artery with color Doppler flow imaging and its clinical significance for sural neurocutaneous flap

作　　者：陈雪松[1] 徐永清[2] 肖茂明[1] 王元山[1] 马志显[1] 管力[1] 张黎明[1] 江珉[1] 

机构地区：[1]云南开远解放军第五十九医院成都军区显微外科中心, 661600 [2]成都军区昆明总医院全军骨科中心

出　　处：《中华整形外科杂志》2010年第6期417-421,共5页Chinese Journal of Plastic Surgery

摘　　要：目的 利用彩色多普勒血流成像技术（color Doppler flow imaging,CDFI）研究小腿外后侧腓动脉主穿支（外径≥0.8 mm）的分布规律,为设计切取穿支腓肠神经营养血管皮瓣提供解剖依据,并评价其在术前穿支体表定位中的应用价值. 方法 运用CDFI探测20名健康志愿者双侧小腿腓动脉主穿支数目、管径及出现位置（腓骨全长自上而下均分9段,按出现顺序依次编号）,并作统计学分析.于2005年1月至2009年1月,根据CDFI术前定位,设计切取腓动脉穿支腓肠神经营养血管皮瓣带蒂或游离移植修复51例小腿、足踝及手部皮肤软组织缺损创面;将术前穿支定位测量与术中确认结果进行比对,分析误差出现原因,总结探测技巧. 结果 每侧小腿平均有腓动脉主穿支4.2支,分布于腓骨头至外踝间连线第2～9段,外径（1.13±0.24）mm（0.80～1.90 mm）;最粗1支外径（1.43±0.29）mm（1.00～1.90 mm）,80.4%分布于第3～5段;最低1支外径（1.02±0.16）mm（0.80～1.30 mm）,分布于第6～9段;主穿支及最大穿支在小腿中1/3的出现几率最多.51块皮瓣均成活,术后未观察到缺血或淤血;术前CDFI穿支探测灵敏度（真阳性率）93.6%,阳性预测值88.0%. 结论 根据腓动脉穿支分布规律,设计切取不同节段主穿支蒂腓肠神经营养血管皮瓣可满足除前足外不同平面小腿及足踝部创面修复需要;最大腓动脉穿支腓肠神经营养血管皮瓣可用于游离移植;CDFI可满足术前穿支定位要求.Objective To study the distribution of the dominant perforators（the diameter ≥ 0.8mm）of the peroneal artery with color Doppler flow imaging（CDFI）for the purpose of anatomical preparations for the perforator sural neurocataneous flap. Methods The dominant perforators of the peroneal artery（DPPA）were studied with CDFI on bilateral legs of 20 healthy volunteers.The numbers,diameters and locations of the perforators were recorded for a statistical analysis.From Jan.2005 to Jan.2009,51 free or pedicled sural neurocutaneous flaps supplied by a single DPPA were designed and harvested to repair the defects near the ankle（n =22）,at the leg（n = 15）and the forefoot or hand dorsum （n = 14）.The perforators were located preoperatively with CDFI and accuracy of CDFI was evaluated intraoperatively.The causes of false results were analysed to improve examining techniques. Results The average number of DPPA was 4.2 with the average diameter of（1.13 ±0.24）mm（0.80-1.90 mm）.They were located in the second to ninth segment of the line from the fibular caput to the tip of lateral malleolus which was equally divided into nine segments.The largest DPPA was（1.43 ± 0.29）mm（1.00-1.90mm）in diameter and most of them were located in the third to fifth segment（80.4%）.The average diameter of the lowest DPPA was（1.02 ±0.16）mm（0.80-1.30 mm）and they were located between the sixth to ninth segment.The total 169 DPPA as well as the largest ones mostly appeared in the middle third of the leg.All of the 51 flaps were transplanted successfully without necrosis,and no vascular problems occurred.Preoperative CDFI examination had a 93.6% true-positive rate and an 88.0% positive predictive value.What should be demonstrated was that if just considered the cases after Dec.2007,the true-positive rate was 97%,and the positive predictive value was 93.9%. Conclusions According to the distribution characteristics of DPPA,a sural neurocutaneous flap pedicled with one of this relatively large perforator can be

关 键 词：外科皮瓣 腓肠神经 彩色多普勒 

分 类 号：R658.3[医药卫生—外科学]