CT灌注成像评估大面积颅骨修补术对覆盖皮瓣血供的影响  

Computed tomographic scalp perfusion in assessing pre and post operative blood perfusion of scalp flaps in cranioplasty

作　　者：朱剑萍[1] 孙勇[1] 张金鹏[2] 赵宁辉[2] 张理超[3] 

机构地区：[1]昆明医科大学第二附属医院放射科,云南昆明650101 [2]昆明医科大学第二附属医院神经外科,云南昆明650101 [3]昆明医科大学第二附属医院普外科,云南昆明650101

出　　处：《实用放射学杂志》2016年第1期107-110,共4页Journal of Practical Radiology

基　　金：云南省应用基础研究计划面上项目（2013FB048）;云南省卫生厅卫生系统学科带头人基金资助项目（D-201221）.

摘　　要：目的 探讨CT头皮灌注评估颅骨修补术前、术后覆盖皮瓣的组织灌注变化。方法 20例大面积颅骨缺损（缺损面积〉25 cm2）患者在早期（〈3月）行颅骨修补术的术前1周、术后2周进行全脑灌注模式扫描。灌注图像采用Functional软件分析比较，测量患者手术侧及对侧覆盖皮瓣的灌注参数值，包括血流量（BF）、血容量（BV）和达峰时间（TTP），计算术侧/对侧相对比值（rBF、rBV及rTTP值）。采用配对t检验比较手术前后CT皮瓣灌注参数值及相对值的差异；并选取5例颅骨修补术后覆盖皮瓣坏死、钛网外露者进行全脑灌注模式扫描，对比患者健侧/坏死侧CT皮瓣灌注图差异。结果 20例早期颅骨修补者，术后皮瓣存活，未见明显坏死。术后术侧皮瓣BF、BV及TTP，rBF、rBV、rTTP与术前 BF、BV及TTP，rBF、rBV、rTTP无明显改变（P值均〉0.05）。5例颅骨修补术后头皮坏死、钛网外露患者坏死侧BF和BV明显低于对侧BF和BV；坏死侧TTP较健侧TTP延长。结论 早期颅骨修补术对覆盖皮瓣血流动力学无明显影响。颅骨修补术后头皮坏死、钛网外露患者灌注图显示坏死侧较健侧血供明显减少。多层螺旋CT头皮灌注能获得术前及术后相应覆盖皮瓣的血供参数值，有助于颅骨修补术患者手术方案的制订及术后皮瓣存活的预测。Objective To discuss the tissue perfusion changes of scalp flaps in cranioplasty. Methods A series scans of tissue per-fusion were performed in twenty patients with large area skull defects in large area （〉25 cm^2） were performed early cranioplasty （〈3 months） and brain per{usion imaging were performed at 1 weeks before operation and 2 weeks post-operation, by a 256-slice CT, and the patiens were performed early cranioplasty. BF, BV, TTP, Relative relative BF （ rBF）, relative BV （rBV） and relative TTP （rTTP） were obtained and measured in functional maps at the areas of scalp flaps and contralateral mirroring areas. The differences in perfusion CT values of pre and post operative skull neoplasty skin grafts were assessed with the paired t test. The parameters of scalp flap perfusion of five cranioplasty patients with post operative skin grafts necrosis were also obtained and analyzed. Results All of the twenty patiens with early cranioplasty had no complication of flaps. Post operative,BF,BV and TTP,rBF, rBV and rTTP values of the operated sides had no significant with the those before operatio （P〉0.05）. For the five patients with post operative skin grafts necrosis,BF and BV values of the necrosis side was significantly lower than the contra lateral mirroring areas. The TTP value of the the necrosis sides was significantly higher than the contra lateral mirroring areas. Conelusion The early eranioplasty have no impacts on haemodynamiesblood micro circulation of scalp flaps. The perfusion images showed that the blood perfusions of necrosis skin grafts were lower than that of contralateraI mirroring areas. This study shows that skin grafts perfusion of the low-dose radiation CT scanning is helpful for the operation strategy and can predict skin grafts＇ survival.

关 键 词：颅骨修补术 计算机体层成像 血管造影术 血流动力学 

分 类 号：R687.3[医药卫生—骨科学] R814.42[医药卫生—外科学]