3D打印技术结合股前外侧穿支皮瓣修复外伤术后重度虎口挛缩  

3D printing technique combined with anterolateral thigh perforator flap for repair of severe contracture of the thumb web after trauma operation

作　　者：王凯[1] 巨积辉[1] 金光哲[1] 郭礼平[1] 李亚东 陆兆威 张向南 柳志锦 Wang Kai;Ju Jihui;Jin Guangzhe;Guo Liping;Li Yadong;Lu Zhaowei;Zhang Xiangnan;Liu Zhijin(Department of Hand Surgery,Ruihua Affiliated Hospital of Suzhou University,Suzhou 215104,China)

机构地区：[1]苏州大学附属瑞华医院手外科,苏州215104

出　　处：《中华手外科杂志》2021年第2期91-93,共3页Chinese Journal of Hand Surgery

基　　金：江苏省青年医学人才项目(QNRC2016223)。

摘　　要：目的探讨运用3D打印镜像技术术前精确设计股前外侧穿支皮瓣,治疗外伤性重度虎口挛缩的临床疗效。方法自2017年12月至2020年1月我科收治外伤后重度虎口挛缩患者11例,虎口角平均(20.5±3.5)°,虎口宽度平均(2.5±0.3)cm,术前画出患侧手术切口线,根据体表标志在健侧相对位置画出切口线,根据健侧虎口设计图形,通过3D镜像技术直接打印出患侧开大至正常后的虎口创面的形状及大小,根据样布设计皮瓣,术前B超探查股前外侧区域穿支口径及位置,以直径在0.8 mm以上穿支为皮瓣供血动脉,术前即可设计画线,术中彻底松解挛缩虎口,采用对侧股前外侧穿支皮瓣游离移植修复,切取游离皮瓣面积为9.0 cm×4.5 cm~11.0 cm×6.0 cm,皮瓣供区均直接缝合。术后采用医用高分子夹板固定拇指于外展对掌位4周,行系统康复理疗。结果术后11例皮瓣全部存活,无血管危象,供区均Ⅰ期愈合,随访5~14个月,平均10个月,虎口外形明显改善,两点分辨觉10~15 mm,虎口角平均(89.5±3.5)°,虎口宽度平均(5.9±0.8)cm,拇对掌、对指及其内收、外展活动良好。结论应用3D打印技术可明显缩短术中皮瓣设计时间,设计也更加精确,股前外侧穿支皮瓣修复虎口挛缩创面临床效果良好,能有效防止术后虎口再度挛缩。Objective To explore the clinical efficacy of preoperative accurate design of anterolateral thigh perforator flap using 3D printing mirror technique in the treatment of severe traumatic contracture of the thumb web.Methods From December 2017 to January 2020,11 patients with severe contracture of the thumb web after trauma operation were treated in our department.The average angle of the thumb web was(20.5±3.5)°,and the average width of the thumb web was(2.5±0.3)cm.The surgical incision line of the affected side was drawn before operation,and the incision line was drawn at the relative position of the uninjured side according to the body surface marks.According to the designed graphics of the uninjured thumb web,the 3D mirror technique was used to directly print the shape and size of the wound on the affected side.The flap was designed according to the sample cloth.The diameter and position of the perforator in the anterolateral femoral region were detected by ultrasound before operation.The perforators with a diameter of more than 0.8 mm were used as the blood supply artery of the flap.The contralateral anterolateral thigh perforator flap was used to repair the contracture.The area of free flap was 9.0 cm×4.5 cm to 11.0 cm×6.0 cm.The donor site of flap was sutured directly.After operation,the thumb was fixed in abduction and opposition position with medical polymer splint for 4 weeks.Results All the flaps survived without vascular crisis.All the donor sites achieved primary healing.All the flaps were follow-up for 5 to 14 months with an average of 10 months.The shape of the thumb web was improved significantly.The two-point discrimination was 10 to 15 mm.The average angle of the thumb web was(89.5±3.5)°.The average width of the thumb web was(5.9±0.8)cm.The movement of thumb opposition,adduction and abduction were good.Conclusion The application of 3D printing technique can significantly shorten the intraoperative flap design time,and the design is more accurate.The clinical efficacy of anterolateral thigh

关 键 词：外科皮瓣 显微外科手术 虎口挛缩 3D打印技术 

分 类 号：R658.2[医药卫生—外科学]