彩色多普勒超声与CT血管造影技术在游离骨间后动脉穿支皮瓣术前评估中的应用比较研究  

A comparative study of color Doppler ultrasound and CT angiography for preoperative evaluation of perforator vessels in free posterior interosseous artery flap

作　　者：王鸿权 刘珊珊 谢英志 胡浩良[3,4] 李苗钟 WANG Hongquan;LIU Shanshan;XIE Yingzhi;HU Haoliang;LI Miaozhong(Department of Radiology,Ningbo Sixth Hospital,Ningbo Zhejiang,315040,P.R.China;Department of Ultrasound,Ningbo Sixth Hospital,Ningbo Zhejiang,315040,P.R.China;Department of Hand Surgery,Ningbo Sixth Hospital,Ningbo Zhejiang,315040,P.R.China;Ningbo Clinical Research Center for Orthopedics,Sports Medicine&Rehabilitation,Ningbo Zhejiang,315040,P.R.China)

机构地区：[1]宁波市第六医院放射科,浙江宁波315040 [2]宁波市第六医院超声科,浙江宁波315040 [3]宁波市第六医院手外科,浙江宁波315040 [4]宁波市骨科与运动康复临床医学研究中心,浙江宁波315040

出　　处：《中国修复重建外科杂志》2025年第4期483-487,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：宁波市重大科技任务攻关项目(2022Z146);宁波市医学科技计划项目(2021Y53)。

摘　　要：目的探讨游离骨间后动脉穿支皮瓣术前应用彩色多普勒超声(color Doppler ultrasound,CDU)与CT血管造影(CT angiography,CTA)技术定位穿支血管的准确性。方法2020年1月—2023年12月,收治19例外伤导致的手部皮肤软组织缺损患者。男11例,女8例;年龄26~54岁,中位年龄45岁。受伤至手术时间5~11 d,平均7.2 d。手背皮肤软组织缺损8例,手指11例;缺损范围4.0 cm×2.5 cm~7.5 cm×3.5 cm。术前经CDU及CTA定位穿支血管后,设计游离骨间后动脉穿支皮瓣修复手部缺损,切取范围为4.5 cm×3.0 cm~7.5 cm×4.0 cm;供区均直接拉拢缝合。比较CDU及CTA探测骨间后动脉穿支血管数量、管径,并与术中观测结果进行比较,计算正确率及识别率。术后观察皮瓣成活情况,采用温哥华瘢痕评分(VSS)评价供区愈合,视觉模拟评分(VAS)评价患者对皮瓣外观满意度。结果术前CDU评估骨间后动脉穿支血管(5.8±1.2)条、管径(0.62±0.08)mm,CTA评估分别为(5.2±1.0)条、(0.60±0.07)mm,差异均无统计学意义(P>0.05)。术中见骨间后动脉穿支血管数量、走行和分布与术前CDU、CTA三维重建后穿支血管图像基本一致。与术中观测结果相比,CDU及CTA定位优势穿支血管识别率分别为95.0%(18/19)和89.5%(17/19),正确率分别为100%(19/19)和84.2%(16/19),差异均无统计学意义(P>0.05)。术后皮瓣均成活,创面及供区切口Ⅰ期愈合。患者均获随访,随访时间6~13个月,平均8.2个月。末次随访时患者皮瓣弹性充足,质地柔软,患者满意度VAS评分为(9.2±0.8)分。供区情况愈合良好,瘢痕增生不明显,VSS评分为(11.7±0.9)分。结论CDU和CTA均可准确识别穿支血管并定位优势穿支血管,有利于精准切取皮瓣,减少供区损伤。但在前臂穿支血管检测中,CDU对于穿支血管远端的显影更具优势。Objective To investigate the accuracy of color Doppler ultrasound(CDU)and CT angiography(CTA)in the preoperative evaluation of perforator vessels in free posterior interosseous artery perforator(PIAP)flaps.Methods Between January 2020 and December 2023,19 patients with hand skin and soft tissue defects caused by trauma were admitted.There were 11 males and 8 females,with a median age of 45 years(range,26-54 years).The interval between injury and admission was 5-11 days(mean,7.2 days).The skin and soft tissue defects were located on the dorsum of the hand in 8 cases and on the fingers in 11 cases.The size of defect ranged from 4.0 cm×2.5 cm to 7.5 cm×3.5 cm.After locating the perforator vessels through CDU and CTA before operation,the free PIAP flaps were designed to repair hand defects,with the size of 4.5 cm×3.0 cm-7.5 cm×4.0 cm.The defects of donor sites were directly sutured.The number and diameter of perforator vessels in the posterior interosseous artery detected by CDU and CTA were compared.The differences in localization of perforator vessels using CDU and CTA and their clinical effects were also compared to calculate the accuracy and recognition rate.During follow-up,the survival of the skin flap was observed,and the Vancouver scar scale(VSS)score was used to evaluate the healing of the donor site,while the visual analogue scale(VAS)score was used to evaluate the patient’s satisfaction with the appearance of the skin flap.Results The number and the diameter of PIAP vessels was 5.8±1.2 and(0.62±0.08)mm assessed by CDU and 5.2±1.0 and(0.60±0.07)mm by CTA,showing no significant difference between the two methods(P>0.05).The number,course,and distribution of perforator vessels of the PIAP vessels observed during operation were basically consistent with those detected by preoperative CDU and CTA.Compared with intraoperative observation results,the recognition rates of dominant perforating vessels by CDU and CTA were 95.0%(18/19)and 89.5%(17/19),respectively,and the accuracy rates were 100%(19/19)and

关 键 词：穿支皮瓣 骨间后动脉 彩色多普勒超声 CT血管造影 

分 类 号：R658.3[医药卫生—外科学]