三维CT血管造影在旋髂深动脉组织瓣修复下颌骨缺损中的临床应用  

The clinical application of 3-dimensional CT angiography in the repair of mandibular defects with deep circumflex iliac arterial flap

作　　者：李孝亮 廖圣恺[1] 陈永锋[1] 展昭均 洪虓[1] 都晓英[2] 余松涛[3] 耿琳雅 Li Xiaoliang;Liao Shengkai;Chen Yongfeng;Zhan Zhaojun;Hong Xiao;Du Xiaoying;Yu Songtao;Geng Linya(Department of Stomatology,First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of Ultrasound,First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of Radiology,First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]蚌埠医学院第一附属医院口腔科,233004 [2]蚌埠医学院第一附属医院超声科,233004 [3]蚌埠医学院第一附属医院放射科,233004

出　　处：《中华整形外科杂志》2021年第5期495-500,共6页Chinese Journal of Plastic Surgery

基　　金：2018年度安徽高校自然科学重点研究项目(KJ2018A1005)。

摘　　要：目的探讨三维CT血管造影在旋髂深动脉组织瓣修复下颌骨缺损中的临床应用效果。方法2019年1月至2020年1月蚌埠医学院第一附属医院口腔科收治5例下颌骨肿瘤术后缺损患者,男2例,女3例,年龄30~70岁,平均52岁。术前行双下肢三维CT血管造影,利用CT工作站进行数据处理,根据术区缺损大小、形状,构建旋髂深动脉组织瓣三维模型,观察并测量旋髂深动脉走行、起始点管径、起始点至髂前上棘连线与双侧髂前上棘连线的夹角及起始点至髂前上棘的距离。术中依据旋髂深动脉组织瓣三维模型,设计并制备以旋髂深动脉为蒂复合组织瓣,并进行下颌骨缺损修复,同时将术中实际情况与术前旋髂深动脉组织瓣三维模型进行对比。结果共测得5例旋髂深动脉起始点管径(2.30±0.24)mm,旋髂深动脉起始点至双侧髂前上棘连线的夹角39.3°±6.1°,起始点至髂前上棘的距离(5.83±0.24)cm。术中观察到旋髂深动脉走行、位置与三维模型基本一致,术后随访3~6个月,所有皮瓣均移植成功,患者两侧颌面部基本对称,术后影像学检查示髂骨瓣愈合良好,下颌牙槽嵴高度、宽度恢复满意,供区无麻木、腹疝及步态异常等并发症。结论由三维CT血管造影制作旋髂深动脉组织瓣三维模型,可准确定位旋髂深动脉位置、走行,清楚显示目标血管周围皮肤、肌肉、骨骼之间的三维空间关系,明显减少供区并发症及手术时间。Objective To investigate the clinical application of 3-dimensional CT angiography(3D-CTA)in the repair of mandibular defects with deep circumflex iliac arterial flaps.Methods From January 2019 to January 2020,5 patients with postoperative defects of mandibular tumors were treated in the Department of Stomatology of the First Affiliated Hospital of Bengbu Medical College,including 2 males and 3 females.The ages of the patients ranged from 30 to 70 years,with an average of 52 years.CT angiography of both lower limbs was performed before operation.Data were processed using the CT workstation.According to the size and shape of the defect in the recipient site,the 3D model of the deep circumflex iliac arterial flap(DCIA)was constructed.the contour of the DCIA was observed and measured,and the data was recorded,including the diameter of the vassel at the starting point,the angle between the line from the starting point to the anterior superior iliac spine and the line between the bilateral anterior superior iliac spine,and the distance from the starting point to the anterior superior iliac spine.According to the 3D model,a composite tissue flap pedicled with DCIA was designed and prepared for mandibular defect repair.The actual situation during the procedure was compared with the preoperative 3D model simultaneously.Results The diameter of the DCIA at the starting point was(2.30±0.24)mm.The angle between the line from the starting point to the anterior superior iliac spine and the line between the bilateral anterior superior iliac spine was 39.3°±6.1°,and the distance from the starting point to the anterior superior iliac spine was(5.83±0.24)cm.The shape and position of the DCIA were basically consistent with the three-dimensional model.All the flaps survived well after operation.All the patients were followed up for 3 to 6 months,the bilateral maxillofacial region were basically symmetrical.The postoperative imaging examination showed that the iliac osteocutaneous flap healed well,and the height and width of mand

关 键 词：旋髂深动脉 CT血管造影 成像 三维 下颌骨缺损 

分 类 号：R782.2[医药卫生—口腔医学]