小腿链式穿支皮瓣血管三维重建的解剖学研究  

Anatomical study on three-dimensional vascular reconstruction of calf chain perforator flap

作　　者：谭琪 张永强 王昌德 刘刚 王谦 李振 杨磊 刘光军 Tan Qi;Zhang Yongqiang;Wang Changde;Liu Gang;Wang Qian;Li Zhen;Yang Lei;Liu Guangjun(Department of Orthopedics,Weifang People’s Hospital,Weifang 261041,China;Dongjin Research Institute of Basic Medicine,Shandong Province,Weifang 261021,China;Department of Orthopedics,Hospital of the 80th Group Army of the PLA,Weifang 261021,China)

机构地区：[1]潍坊市人民医院创伤骨科,潍坊261041 [2]山东省东进基础医学研究所,潍坊261021 [3]解放军陆军第八十集团军医院创伤骨科,潍坊261021

出　　处：《中华整形外科杂志》2023年第5期490-495,共6页Chinese Journal of Plastic Surgery

基　　金：潍坊市卫健委资助课题(wfwsjk_2019_024)。

摘　　要：目的探讨小腿动脉穿支血管的三维重建方法,为临床安全而准确地切取小腿链式穿支皮瓣提供依据。方法取新鲜的成人尸体下肢标本3侧(全军创伤骨科研究所实验室提供),以明胶-氧化铅自股动脉灌注,CT扫描全段肢体后采集数据,导入Mimics Research 19.0软件中对骨骼、动脉及其穿支体进行三维重建,通过调整CT值动态显示血管层次结构和毗邻关系,并以不同颜色显示各穿支动脉的解剖学区域,利用Scion Image软件测量单一穿支的供血面积;三维打印小腿骨骼及血管模型用于直视观察;标本解剖以三维重建的穿支血管参数规划解剖入路,以穿过深筋膜处外径≥0.5 mm的穿支为测量对象,观测穿支的数量、血管蒂长、外径等参数并进行统计分析。结果 CT三维重建图像能够清晰显示小腿动脉及其穿支血管、微细血管的三维结构,以及血管的走行、分布特点、与毗邻结构的三维关系等。打印的三维模型可直观地观察穿支血管的层次和穿支间的吻合关系。3侧小腿标本动脉发出穿支(22±4)条,血管蒂长(46.7±18.3) mm,穿支血管外径为(0.8±0.3) mm,单穿支分布面积为(38.2±10.7) cm^(2)。结论应用Mimics Research 19.0软件通过调整CT值可重建小腿源动脉及穿支血管三维结构,改善了穿支血管的显示效果;三维打印模型使得穿支血管的来源、走行、外径及分布范围直观可见,为临床构建患者数字化小腿链式穿支皮瓣切取方案提供实验支持。Objective The three-dimensional(3D)reconstruction method of calf perforator vessel was explored to provide the basis for clinical safe and accurate harvesting of calf chain perforator flap.Methods Gelatin-lead oxide is automatically perfused the femoral artery of 3 fresh adult lower limbs specimens.Data were collected after the CT scan of the full limb,3D reconstruction of bones,arteries and their perforators was processed in Mimics Research 19.0 software.Dynamic display of vascular hierarchy and adjacent relationships by adjusting CT values.And show the anatomical region of each perforator artery in different colors,measure the feeding area of the single perforator using Scion Image software.The 3D printed calf bone and vascular model can be used for direct observation.The specimen anatomy was measured according to a perforator vessel parameter with an outer diameter of 0.5 mm through the deep fascia.The number of perforators,vessle pedicle length,and outer diameter were observed and statistically analyzed.Results The digitized 3D reconstruction images can clearly show the 3D structured of the calf artery and perforator vessels and micro vessels,as well as the course,distribution characteristics of blood vessels,and the 3D relationship with adjacent structures.The printed 3D model visually observes the hierarchy of the perforator vessels and the anastomosis relationship between the perforators.3 calf specimen arteries with perforator artery 22±4,vessel pedicle length(46.7±18.3)mm,outer diameter(0.8±0.3)mm,the average blood supply area of the single perforator(38.2±10.7)cm^(2).Conclusion The Mimics Research 19.0 software should be used to dynamically reconstruct the 3D structure of the branch vessel by adjusting the CT value,which improves the display effect of the perforator vessels.The 3D printing model makes the source,course,diameter and distribution range of the perforator vessels visually visible,which provides experimental support for the clinical construction of digital calf chain perforator flap harv

关 键 词：外科皮瓣 穿支皮瓣 链式血管 三维重建 三维打印 

分 类 号：R658.3[医药卫生—外科学]