CTA技术辅助第1趾蹼动脉分型在拇指再造中的应用  

A CTA-based classification of first plantar metatarsal arteries in thumb reconstruction

作　　者：许林[1] 谭嘉 秦豪[1] 莫勇军[1] 韦平欧[1] 罗翔[1] 程志琳 谭海涛[1] XU Lin;TAN Jia;QIN Hao;MO Yongjun;WEI Ping’ou;LUO Xiang;CHENG Zhilin;TAN Haitao(Department of Hand-Foot Microsurgical Orthopedics Surgery,Guigang People's Hospital,Guigang,Guangxi Zhuang Autonomous Region 537100,China;Department of Orthopedics,Shanghai Ninth People's Hospital of Shanghai JiaoTong University School of Medicine,Shanghai 200011,China)

机构地区：[1]贵港市人民医院手足显微骨科,广西壮族自治区贵港537100 [2]上海交通大学医学院附属第九人民医院骨科,200011

出　　处：《中华显微外科杂志》2020年第5期454-458,共5页Chinese Journal of Microsurgery

基　　金：广西医科大学青年科学基金项目(GXMUYSF201640);广西科技计划项目(桂科AD17195042,桂科AD17129017);贵港市科技开发计划项目(贵科通1834002)。

摘　　要：目的探讨CTA技术在第1趾蹼动脉分型中的有效性及其对拇指再造术的应用价值。方法2015年12月至2018年12月期间,行游离第2足趾或甲瓣移植再造拇指手术36例,其中机器绞压伤22例,重物砸伤7例,碾压伤7例,术前通过CTA评估第1趾蹼动脉分支情况,并将CTA影像学结果和术中解剖结果进行对比分析,根据第1趾蹼动脉特点选择游离甲瓣或者第2足趾移植再造拇指术。结果CTA结果显示有35例70足能很好显示第1趾蹼动脉的起源、走行及其与周围组织的三维解剖关系,1例2足(2.78%)CTA显示血管连续性较差且有伪影。根据CTA显示结果,按趾蹼处第1趾蹼动脉分支情况,29例58足(80.56%)为分叉型,5例10足(13.88%)为主干型,1例2足(2.78%)为细支型。35例患者第1趾蹼动脉CTA检查结果与术中所见分型一致;根据血管分支情况,最终27例行游离甲瓣移植再造拇指术,8例行游离第2足趾移植再造拇指术;另1例CTA显示血管连续性较差患者也行游离甲瓣移植再造拇指术。36例拇指再造术后全部成活,术后36例均获得随访6~24(平均12)个月,拇指外观、功能良好,感觉恢复良好,供区恢复良好。结论通过CTA技术可获得第1趾蹼动脉的高质量三维图像,术前可评估供区血管情况,为供区手术规划设计提供依据,也为进一步研究在拇指再造术中降低供区致残率提供参考。Objective To discusses effectiveness of CTA in the classification of first plantar metatarsal artery and its application value in thumb reconstruction.Methods Thirty-six cases who underwent thumb reconstruction with free second toe or hallucis flap between December,2015 and December,2018 were retrospectively analyzed.Among these cases,22 cases were injured by machine stranding,7 cases by heavy objects,and 7 cases were injured by rolling.Exact first plantar metatarsal arteries of all these cases were evaluated by using CTA preoperatively.And compared with intraoperative findings at the donor sites.Free first or second toe flap for thumb reconstruction were designed preoperatively based on branching pattern of first plantar metatarsal arteries.Results The origin,course,3-dimensional(3D)anatomical relationship with surrounding tissues and branching pattern of all these feet first plantar metatarsal arteries of 35 cases(70 feet)were well displayed in CTA images,and 1 case(2 feet)were showed poor vascular continuity and artifacts in CTA(2.78%).According to the branching pattern of first plantar metatarsal arteries,29 cases(58 feet,80.56%)were ramifying type,5 cases(10 feet,13.88%)were main trunk type,and 1 case(2 feet,2.78%)were tiny branch type.Preoperative CTA images and intraoperative findings at the donor site of 35 cases were remarkably consistent.According to CTA images,27 cases underwent thumb reconstruction with hallucis flap,8 cases underwent thumb reconstruction with second toe,and 1 case of poor vascular continuity and artifacts in CTA underwent thumb reconstruction with hallucis flap eventually.All these cases were followed-up for 6-24(average 12)months,and all reconstructed thumbs survived.The clinical outcomes of all these reconstructed thumbs were good with satisfactory appearance,sensory recovery,excellent motion.The donor feet of all cases recovered well.Conclusion High-quality 3D images of first plantar metatarsal arteries could be obtained by CTA,allowing preoperative assessment of blood supply and

关 键 词：拇指再造 CTA技术 第1趾蹼动脉 分型 显微外科技术 

分 类 号：R658.1[医药卫生—外科学]