3D数字减影血管造影联合彩色多普勒超声穿支血管定位技术在股前外侧穿支皮瓣修复小腿创面中的临床应用  

Clinical application of 3D digital subtraction angiography combined with color Doppler flow imaging in repairing leg wounds with anterolateral thigh perforator flap

作　　者：李昌松 李雷 周正虎 夏宇航 徐磊 余向南 张心玉 巨积辉 Li Changsong;Li Lei;Zhou Zhenghu;Xia Yuhang;Xu Lei;Yu Xiangnan;Zhang Xinyu;Ju Jihui(Department of Traumatic Orthopedics,Suzhou Ruihua Orthopedic Hospital,Suzhou 215104,China)

机构地区：[1]苏州瑞华骨科医院创伤骨科,215104

出　　处：《中华损伤与修复杂志(电子版)》2025年第1期7-12,共6页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：苏州市科技计划项目(SKYD2022073)。

摘　　要：目的探讨在股前外侧穿支皮瓣(ALTPF)修复小腿保肢术后创面术前,组合式应用3D数字减影血管造影(3D-DSA)联合彩色多普勒超声(CDFI)精准定位ALTPF穿支血管及小腿受区血管的应用价值。方法2022年6月至2023年6月苏州瑞华骨科医院创伤骨科通过对25例小腿保肢术后患者创面采用股前外侧穿支皮瓣覆盖,术前应用3D-DSA联合CDFI定位ALTPF穿支血管以及小腿创面受区血管,统计术前皮瓣穿支血管定位位置、皮瓣穿支数目、口径、穿支类型,小腿创面受区血管类型、口径。术中记录皮瓣穿支数目、口径、穿支类型以及皮瓣血管蒂同小腿创面受区血管口径适配率,验证术前组合式定位的准确性、皮瓣切取效率性。术后记录皮瓣成活率以及皮瓣供区并发症。结果25例患者经3D-DSA结合CDFI组合定位发现穿支70条,术中实际使用穿支40条,其他未使用穿支血管未进行来源追溯,术中所使用穿支均属于术前定位穿支,阳性预测值为100%,术中所测得血管蒂长度8~18 cm,平均12.96 cm;术前所对应预测血管蒂长度7~19 cm,平均13.76 cm,差异值在1~3 cm;携带血管主干近端口径1.55~1.90 mm,平均1.77 mm,同受区血管均能匹配吻合,根据术前设计皮瓣满足术中创面修复要求。术前造影曝光时间30~70 s,平均45 s。手术切取皮瓣时间10~60 min,平均25 min。25例皮瓣均顺利存活,皮瓣供受区均Ⅰ期愈合,术后皮瓣未出现血管危象。皮瓣覆盖后住院时间14~60 d,平均25 d。术后随访6~18个月,伤口无感染,皮瓣色泽红润,无明显色素沉着,质地柔软,外形良好。术后骨折均愈合。结论通过3D-DSA联合CDFI对血管进行组合定位,可较准确地定位ALTPF穿支血管及小腿创面受区血管,为游离ALTPF移植修复小腿保肢后复杂创面,提供良好的术前规划,值得临床参考应用。Objective Exploring the clinical application value of the combination of 3D digital subtraction angiography(3D-DSA)and color Doppler flow imaging(CDFI)for positioning precisely on the perforator vessels in the preoperative evaluation of the anterolateral thigh perforator flap(ALTFP)for repairing lower limb defects after leg salvage surgery.Methods From June 2022 to June 2023,25 cases of wounds after lower leg limb-sparing surgery were covered with ALTFP in Department of Traumatic Orthopedics of Suzhou Ruihua Orthopedic Hospital.Prior to surgery,3D-DSA combined with CDFI was used to locate the perforator vessels of ALTFP and the vessels in the affected area of the leg wound.The preoperative location of the perforator vessels in the skin flap,the number,diameter,and type of perforator were recorded,as well as the type and diameter of the vessels in the affected area of the leg wound were recorded.The number,diameter,type of perforations of the skin flap during surgery,as well as the compatibility rate between the vascular pedicle of the skin flap and the diameter of the blood vessels in the affected area of the leg wound were recorded,to verify the accuracy of preoperative combined positioning and the efficiency of skin flap harvesting.Postoperative flap survival rate and complications in the flap donor site were collected.Results In this series of 25 cases,the combination of 3D-DSA and CDFI was used to identify 70 perforators,of which 40 were actually utilized during surgery.The remaining unused perforators were not traced back to their origins.All the perforators used in the surgery were the preoperatively localized ones,with a positive predictive value of 100%.The average length of the vascular pedicles measured intraoperatively was 12.96(8-18)cm,and the average predicted length of the vascular pedicles before surgery was 13.76(7-19)cm,with the difference within 1-3 cm.The average proximal caliber of the main vessel was 1.77(1.55-1.90)mm,which could be matched and anastomosed with the recipient area vessels.Acco

关 键 词：创面 股前外侧穿支皮瓣 血管造影术 数字减影 定位技术 

分 类 号：R74[医药卫生—神经病学与精神病学]