彩色多普勒超声成像在先天性并指术前血管评估中的应用  

Application of pre-operative color Doppler-guided analysis of vascular distribution in syndactyly

作　　者：王金萍 印飞 王希明[3] 顾珺 黄海 Wang Jinping;Yin Fei;Wang Ximing;Gu Jun;Huang Hai(Department of Functional Section,Wuxi Ninth People’s Hospital Affiliated to Soochow University,Wuxi 214062,China;Suzhou Medical College,Soochow University,Suzhou 215123,China;Department of Radiology,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]无锡市第九人民医院功能科,无锡214062 [2]苏州大学苏州医学院,苏州215123 [3]苏州大学附属第一医院放射科,苏州215000

出　　处：《中华整形外科杂志》2023年第12期1331-1336,共6页Chinese Journal of Plastic Surgery

基　　金：海东市科技局东西部协作科研项目(2021-HDKJ-Y12)。

摘　　要：目的应用彩色多普勒超声血管成像技术观察先天性并指畸形指掌侧总动脉走行情况,同时根据动脉分叉点高低制定分型,并探讨其临床意义。方法回顾性分析2017年1月至2022年12月无锡市第九人民医院收治的先天性并指畸形患儿资料。术前完善手部血管超声检查,行并指指蹼区指掌侧总动脉分叉点定位。以近节指骨近1/3点为基准点,以分叉点与基准点间的距离为指标,对指掌侧总动脉分叉点变异情况进行分型,包括正常型(<0 mm)、轻度降低型(0~5 mm)、中度降低型(6~10 mm)、重度降低型(>10 mm)、缺如型(并指间仅有1条动脉)。记录患儿指掌侧总动脉分叉点总变异情况及分型占比。根据分型情况制定相应手术方案,以术中实际探测到的指掌侧总动脉分叉点为金标准,计算彩色多普勒超声血管成像的定位准确率。观察患儿术后感染、皮瓣坏死、指体血管痉挛等并发症发生情况及末次随访指蹼形态。采用描述性方法进行统计分析。结果共纳入123例并指患儿(181个指蹼),其中男72例,女51例;年龄10~28个月;单纯型并指55例,复杂型(骨性)并指36例,Poland综合征并指32例。彩色多普勒超声血管成像显示,指掌侧总动脉分叉点总变异率为24.3%(44/181),其中轻度降低型占11.6%(21/181),中度降低型占8.3%(15/181),重度降低型占3.3%(6/181),缺如型占1.1%(2/181)。单纯型并指、骨性并指、Poland综合征并指的血管变异率分别为0(0/55)、19.5%(7/36)、41.1%(37/90)。与术中实际情况相比,彩色多普勒超声血管成像的定位准确率达100%。所有患儿手术均顺利完成,皮瓣及皮片均顺利存活,术后未出现感染、血管危象及指体坏死等并发症。所有患儿均获得随访,随访时间6~27个月,平均13.5个月。末次随访时指蹼深度、宽度、坡度均接近正常。结论先天性并指畸形指掌侧总动脉分叉点变异率较高,骨性并指及Poland综合征并指有必�Objective To analyze the vascular distribution of palmar digital arteries in syndactyly through color Doppler ultrasound angiography and make the classification according to the level of artery bifurcation points,discusse its clinical significance.Methods A retrospective analysis was performed for the data of children with congenital and digital malformations admitted to Wuxi Ninth People’s Hospital from January 2017 to December 2022.Preoperative vascular ultrasonography of the hand was performed to locate the bifurcation point of the common palmar digital artery in the digital webbed area.The vascular conditions were classified according to the distance between the bifurcation point and the 1/3 point of the proximal phalangeal as the reference,such as normal type(<0 mm),mild reduction type(0-5 mm),moderate decrease type(6-10 mm),and severe reduction type(>10 mm),absent type(only 1 artery between the fingers).The total variation of the bifurcation point of the common palmar digital artery in the children,as well as the proportion of different vascular condition subtypes were recorded.According to the classification of blood vessels,the corresponding operation plan was made.The positioning accuracy of color Doppler ultrasound angiography was evaluated based on the gold standard of common palmar digital artery bifurcation points detected during operation.Complications such as postoperative infection,flap necrosis,finger vasospasm and the morphology of finger web at the last follow-up were observed.Descriptive statistical analysis was used.Results A total of 123 children with 181 finger webs were enrolled,including 72 males and 51 females,aged 10-28 months.There were 55 cases of simple type,36 cases of complex type(bone)and 32 cases of Poland syndrome.Color Doppler ultrasound angiography showed that the total variation rate of the common palmar digital arterial bifurcation point was 24.3%(44/181),of which 11.6%(21/181)were mildly reduced type,8.3%(15/181)were moderately reduced type,3.3%(6/181)were severe reduced

关 键 词：手畸形 先天性 并指症 超声检查 多普勒 彩色 指掌侧总动脉 

分 类 号：R726.8[医药卫生—儿科]