CT血管造影和彩色多普勒在腓肠内侧动脉穿支皮瓣的定位比较  

Comparison of CT angiography and color Doppler in the localization of medial sural artery perforator flap

作　　者：郭晓峰 强力 薛明宇 周晓 卜凡玉 Guo Xiaofeng;Qiang Li;Xue Mingyu;Zhou Xiao;Bu Fanyu(Department of Hand Surgery,Wuxi No.9 People's Hospital Affiliated to Suzhou University,Wuxi 214062,China)

机构地区：[1]苏州大学附属无锡市第九人民医院手外科,无锡214062

出　　处：《中华手外科杂志》2021年第4期248-250,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨临床上应用CT血管造影技术(CT angiography,CTA)与彩色多普勒超声技术(color Doppler ultrasonography,CDU)在术前腓肠内侧动脉穿支血管的体表定位的准确性差异.方法我科自2015年3月至2018年9月,对54例拟切取腓肠内侧动脉穿支皮瓣修复手背部创面的患者,术前均行CTA和CDU检查,根据穿支血管的口径、位置以及走行方向选择合适的穿支血管,标记出不同检测技术所确定的穿支血管体表定位点,术中以定位点为中心探查穿支血管的实际位置,并与术前结果进行比较分析,评估CTA与CDU定位的准确性。结果术后随访54例皮瓣均存活,1例皮鮮术后边缘暗紫,皮辨表面出现水泡,经及时蒂部拆线、清除皮瓣下方血凝块后存活,术后随访时间6~12个月,皮瓣均I期愈合,经术中验证分析,CDU和CTA对于腓肠内侧动脉皮穿支的识别率分别为96.0%和92.0%,对于穿支的定位准确率分别为94.5%和92.0%,CDU对于穿支血管定位的准确性更高。结论术前穿支血管的定位能够大大提高手术的效率。CDU展现出较CTA更优越的准确性,是一种可靠的术前定位手段。Objective To investigate the difference of the accuracy of surface location of the perforating vessels of the medial sural artery before operation by CT angiography(CTA)and color Doppler ultrasonography(CDU).Methods From March 2015 to September 2018,CTA and CDU were performed in 54 patients who planned to take the medial sural artery perforator flap to repair the wounds of the dorsal hand.According to the diameter,location and direction of the perforator,the appropriate perforator was selected,and the positioning points on the surface of the perforator determined by different detection techniques were marked.During the operation,the actual location of the perforating vessels was explored with the positioning point as the center,and the results were compared with the preoperative results to evaluate the accuracy of CTA and CDU positioning.Results All the 54 flaps survived in the follow-up.One flap had dark purple edge and blisters on the surface of the flap.It survived after removing the stitches from the pedicle and removing the blood clots below the flap.The follow-up time was 6 to 12 months,and all flaps achieved primary healing.After intraoperative validation analysis,the recognition rate of CDU and CTA was 96.0%and 92.0%respectively,and the positioning accuracy of CDU and CTA was 94.5%and 92.0%respectively.Conclusion Ihe preoperative perforator positioning can greatly improve the efficiency of surgery.The CDU is more accurate than CTA,and it is a reliable preoperative localization method.

关 键 词：外科皮瓣 超声检查 多普勒 彩色 腓肠内侧动脉穿支 CT血管造影 

分 类 号：R816[医药卫生—放射医学] R658.3[医药卫生—临床医学]