增强现实技术辅助实施腓骨皮瓣游离移植修复胫骨及其软组织缺损  

Augmented reality assisted technology free fibula flap transplantation in repair of tibia and soft tissue defect

作　　者：莫勇军[1] 谭海涛[1] 杨克勤[1] 许林[1] 罗翔[1] 陆俭军[1] 梁旭权[1] 谭霄 植宁喜 MO Yongjun;TAN Haitao;YANG Keqin;XU Lin;LUO Xiang;LU Jianjun;LIANG Xuquan;TAN Xiao;ZHI Ningxi(Department of Hand and Foot and Micro-orthopaedics,Guigang People's Hospital,Guangxi Zhuang Autonomous Region 537100,China)

机构地区：[1]广西壮族自治区贵港市人民医院手足显微骨科,537100

出　　处：《中华显微外科杂志》2021年第1期24-28,共5页Chinese Journal of Microsurgery

基　　金：广西贵港市科学研究与技术开发计划项目(贵科攻1908036(社自));广西壮族自治区科技计划项目(桂科AD17129017)。

摘　　要：目的探讨增强现实(AR)技术在实施腓骨皮瓣游离移植修复下肢胫骨与软组织缺损的临床价值。方法2017年5月至2019年5月,收治下肢胫骨与软组织缺损9例,术前先对双侧小腿进行CTA扫描,获得胫骨缺损的DICOM数据,通过虚拟手术辅助技术,将设计的腓骨皮瓣及其血供模型图像导入Sina软件,运用AR技术将虚拟腓骨皮瓣信息投影叠加到患者小腿供区体表,进行精准定位下手术。本组实施腓骨皮瓣游离移植切取,皮瓣面积6.0 cm×4.0 cm~12.0 cm×6.0 cm,切取腓骨长度6.0~13.5 cm,修复下肢胫骨缺损长度5.0~12.5 cm,软组织缺损面积5.0 cm×3.0 cm~10.0 cm×4.5 cm。术后定期随访,观察腓骨皮瓣成活情况及修复下肢的功能恢复情况,评价临床效果。结果本组术后腓骨皮瓣全部成活,无血管危象等并发症发生,供区及受区无严重并发症发生。术后随访8~12个月,成活皮瓣质地柔软,血运良好,修复部位外形不臃肿;腓骨与胫骨连接端在3~5个月开始出现骨痂形成,8~12个月时骨性愈合良好,未见骨吸收及骨不连,无螺钉松动或脱落等情况;受区小腿无疼痛症状,站立及行走自如,负重功能接近正常。依照Enneking系统评分:平均27分;优7例,良2例。结论AR技术应用于腓骨皮瓣移植修复胫骨骨缺损辅助手术,临床效果良好,具有一定的实用价值。Objective To investigate the clinical value of the free fibula flap transplantation in repair of the defect of tibia and soft tissue with the help of augmented reality(AR)technology.Methods From May,2017 to May,2019,9 patients with tibial and soft tissue defects were treated.Before operation,CTA scan was performed on both shanks to obtain DICOM data of tibial bone defect.Images of the designed fibular flap and its blood supply model were imported into Sina software through computer virtual surgery assistant technology.With the AR technology,information of virtual fibula flap were projected onto the body surface at the donor site,and the operation was carried out under the precise positioning.In this group,the free fibular flap was harvested with an area of 6.0 cm×4.0 cm-12.0 cm×6.0 cm and the length of fibula was 6.0-13.5 cm.The free fibula flap were used to repair the tibial defect with 5.0-12.0 cm in length and soft tissue defect area at 5.0 cm×3.0 cm-10.0 cm×4.5 cm.Patients were followed-up to observe the survival of fibular flap and the functional recovery of the repaired lower limb,and evaluate the clinical effect.Results All the fibular flaps survived without vascular crisis and without serious complications occurred at both of donor and recipient sites.After 8-12 months of follow-up,the flap was soft in texture and good in blood supply.The appearance of the repair site was not bloated.Callus began to form at the junction of fibula and tibia at 3-5 months and healed well in 8-12 months.No bone resorption,nonunion,loosening or falling off of screws were found.There was no pain in the shank of the recipient area.Patients could stand and walk freely,and the weight-bearing function was close to normal.According to Enneking system,the average score was 27 points;7 cases were excellent and 2 cases were good.Conclusion Application of AR technology in the repair of tibial bone defect with fibular flap transplantation has good clinical effect and has certain practical value.

关 键 词：增强现实技术 腓骨皮瓣 胫骨骨缺损 软组织缺损 显微外科技术 

分 类 号：R658.3[医药卫生—外科学]