数字化技术在穿支皮瓣中的临床应用  

Clinical application of digital technique in perforator flap

作　　者：王永标 梁国平 胡颖 李宇鹏 李长虎 林进标 赵文雅 郑进发 WANG Yongbiao;LIANG Guoping;HU Ying;LI Yupeng;LI Changhu;LIN Jinbiao;ZHAO Wenya;ZHENG Jinfa(0Department of Orthopaedics Traumatology,Yangjiang People＇s Hospital,Yangjiang,Guangdong 529500,China)

机构地区：[1]阳江市人民医院创伤骨科,广东529500

出　　处：《中国骨科临床与基础研究杂志》2018年第2期80-85,共6页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：阳江市科技计划项目(社发[2017]24)

摘　　要：目的研究数字化技术在穿支皮瓣设计及软组织缺损修复中的临床应用。方法选取阳江市人民医院2016年5月至2017年12月收治、需行创面皮瓣修复的34例患者。术前采用基于CT血管造影(CTA)数据、结合Mimics 17.0软件的数字化技术,根据损伤特点对穿支皮瓣进行精确定位和个性化设计,并与术中皮瓣实际测量值进行观测对比,同时记录穿支皮瓣移植及存活情况。结果所有患者均成功完成个性化皮瓣切取。术前采用数字化三维重建技术观测得到的穿支皮瓣动脉及其降支的血管管径及起始位置、血管蒂最大可切取长度、穿支血管来源及走行等,均与术中实际观测结果一致。皮瓣供区肌间隔穿支及肌皮穿支浅动脉血管体表穿出点处管径为0.5~1.2 mm;32支穿支血管管径>0.8 mm,其中>1.0 mm有10支;管径为0.5~0.8 mm的有30支。术中实际测量分别为35、10、34支,准确率为91%、100%、88%。术后除1例出现血管危象外,其余患者皮瓣均顺利成活。结论在软组织缺损修复过程中应用数字化技术,可根据缺损部位的特点进行穿支皮瓣的精准定位与设计,对术中操作有指导作用,降低了手术风险,皮瓣移植成功率高。Objective To study the clinical application of digital technology in perforator flap design and repair of soft tissue defect. Methods A total of 34 patients whose wounds needed skin flap repair in Yangjiang People＇s Hospital from May 2016 to December 2017 were selected. According to the characteristics of injuries,preoperative CT angiography data based digital technology with Mimics 17.0 software was used on the perforator flap for precise positioning and personalized design. Intraoperative actual measured values of the flaps were observed and compared with the preoperative ones, at the same time, perforator flap transplantation and the survival rate were also recorded. Results Personalized flap resections were successfully completed in all patients.By using 3 D reconstruction digital technique, preoperative vascular diameter and starting position of flap arteries and their descending branches, maximum length of vascular pedicle which could be cut, as well as the origin and the shape of perforator blood vessels, were found consistent with the intraoperative ones. Diameter of superficial artery perforated to body surface of intermuscular perforating branch and muscle sheath perforator was 0.5 to 1.2 mm. There were 32 perforating branches whose diameters more than 0.8 mm, in which 10 branches more than1.0 mm, and 30 branches changed from 0.5 to 0.8 mm, while the actual measurement was 35, 10 and 34 branches respectively, with the accuracy rate of 91%, 100% and 88%. Except one case of vascular crisis after the operation, the other skin flap survived smoothly. Conclusion For the repair of soft tissue defect, surgeons can use digital technique to precisely locate and design the perforator flap according to the characteristics of the defect,which is helpful for intraoperative procedure, so as to reduce the risk of surgery, and improve the success rate of flap grafting.

关 键 词：穿支皮瓣 皮肤移植 软组织损伤 修复外科手术 CT血管造影 外科手术 计算机辅助 

分 类 号：R622.1[医药卫生—整形外科] R319.1[医药卫生—外科学]