3D-CTA辅助股前外侧皮瓣修复四肢软组织缺损的临床研究  

Experience of 3D-CTA assisted anterolateral thigh flap repair surgery for soft tissue defects of extremities

作　　者：康光明 白杰[1] 薛鹏 原一帆 Kang Guangming;Bai Jie;Xue Peng;Yuan Yifan(Hand Surgery Center,Honghui Hospital Affiliated to Xi’an Jiaotong University,Xi’an 710000,China)

机构地区：[1]西安交通大学附属红会医院手外诊疗中心,西安710000

出　　处：《中国实用医刊》2024年第21期1-5,共5页Chinese Journal of Practical Medicine

基　　金：陕西省重点研发计划项目(2022SF-211)。

摘　　要：目的探讨三维(3D)-CT血管造影(CTA)辅助股前外侧皮瓣修复四肢软组织缺损的临床效果。方法队列研究。抽取2019年1月至2024年1月西安交通大学附属红会医院收治的四肢软组织缺损患者80例为研究对象,按双色球法分为对照组和观察组,每组40例。两组均接受股前外侧皮瓣修复,对照组术前未实施3D-CTA辅助检查,观察组术前实施3D-CTA辅助检查,且观察组优势穿支术前增加常规体表投影定点。比较观察组术前3D-CTA检查结果与术中实际情况,包括皮瓣范围内的穿支数目、类型、源动脉、分支及穿支管径。以术中检出结果为金标准,比较术前3D-CTA定点、常规体表投影定点检查观察组优势穿支类型的符合率。比较两组皮瓣面积、皮瓣并发症、供区并发症及皮瓣成活率。结果观察组术前3D-CTA检查皮瓣范围内的穿支数目、类型、源动脉、分支及穿支管径与术中实际情况比较,差异未见统计学意义(P>0.05)。观察组72例优势穿支中,术前3D-CTA定点符合率(94.44%,68/72)高于常规体表投影定点(55.56%,40/72),P<0.05。两组皮瓣面积比较差异未见统计学意义(P>0.05);观察组皮瓣并发症发生率(10.00%,4/40)、供区并发症发生率(0,0/40)均低于对照组(30.00%,12/40;12.50%,5/40),观察组皮瓣成活率(100%,40/40)高于对照组(87.50%,35/40),差异有统计学意义(P<0.05)。结论股前外侧皮瓣修复四肢软组织缺损术前予以3D-CTA辅助检查,能更好地把握皮瓣范围内的穿支数目、类型、源动脉、分支及穿支管径等情况,为手术提供更可靠的依据,促进修复手术更加合理及科学,从而保障手术效果,减少皮瓣并发症、供区并发症的发生,提高皮瓣成活率。ObjectiveTo investigate the clinical value of three-dimensional(3D)-computed tomography angiography(CTA)assisted anterolateral thigh flap in repairing soft tissue defects of extremities.MethodsThis study was a cohort study.Eighty patients with soft tissue defect of extremities treated in Honghui Hospital Affiliated to Xi’an Jiaotong University from January 2019 to January 2024 were selected as research objects.And they were divided into the control group and the observation group by bi-colour chromosphere method,with 40 cases in each group.Both groups were treated by anterolateral thigh flap repair surgery.The control group did not undergo 3D-CTA auxiliary examination before surgery,and the observation group underwent 3D-CTA auxiliary examination before surgery.In the observation group,the conventional body surface location examination was performed before surgery for superior perforating branches.The results of preoperative 3D-CTA examination were compared with intraoperative actual condition,including the number,type,source artery,branch,and perforator diameter of perforating branch in the flap area.The coincidence rates of preoperative 3D-CTA examination and conventional body surface location examination in identifying type of superior perforating branch were compared,with actual condition during surgery as the gold standard.The flap size,complication of flap,complications of donor site,and flap survival rate were compared between the two groups.ResultsIn the observation group,the number,type,source artery,branch,and diameter of perforating branches in the flap predicted by preoperative 3D-CTA had no significant difference with actual situation during operation(P>0.05).In detection of superior perforating branch in the observation group,the coincidence rate of preoperative 3D-CTA(94.44%,68/72)was higher than that of conventional body surface location(55.56%,40/72),P<0.05.There was no significant difference in the flap area between the two groups(P>0.05).The incidence of flap complications and donor site comp

关 键 词：穿支皮瓣 软组织缺损 股前外侧皮瓣修复 三维-CT血管造影 皮瓣范围情况 皮瓣并发症 皮瓣成活率 

分 类 号：R658[医药卫生—外科学]