CTA三维重建技术在游离双叶股前外侧穿支皮瓣移植修复四肢创面中的效果  

Efficacy of computed tomographic angiography three-dimensional reconstruction technology in repair of limb wounds using free double-leaf anterolateral thigh perforator flaps

作　　者：蓝波 傅尚俊[1] 刘涛 吴建龙 杨锦[1] Lan Bo;Fu Shangjun;Liu Tao;Wu Jianlong;Yang Jin(Department of Hand and Foot Surgery,Yiwu Central Hospital of Zhejiang Province,Yiwu 322000,China;Department of Hand and Foot Surgery,Zhejiang Provincial People's Hospital,Hangzhou 310014,China)

机构地区：[1]浙江省义乌市中心医院手足外科,义乌322000 [2]浙江省人民医院手足外科,杭州310014

出　　处：《中华医学美学美容杂志》2025年第2期148-154,共7页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：浙江省义乌市科研计划项目(20⁃3-156);浙江省义乌市科技局项目(2020-31)。

摘　　要：目的探讨计算机断层血管造影(CTA)三维重建技术在游离双叶股前外侧穿支皮瓣移植修复四肢创面中的效果。方法回顾性纳入2015年1月至2022年3月浙江省义乌市中心医院手足外科及浙江省人民医院手足外科四肢皮肤不同程度受损患者30例,根据术前是否进行CTA三维重建分为观察组(n=15)和对照组(n=15)。观察组:术前进行CTA三维重建,男9例,女6例,年龄17~67(49.7±4.2)岁;对照组:术前进行手持多普勒超声血管成像,男10例,女5例,年龄20~69(50.4±5.0)岁。比较两组患者术中和术后的相关指标,包括手术时长、麻醉复苏时间、出血量、穿支定位准确率、供区与受区血管吻合率、皮瓣切取时间、皮瓣成活率、不良反应发生率。通过电话或门诊进行术后3个月的随访,每个月随访1次,评估患者满意率。建立多准则决策模型,并对两组效益值、风险值及决策模型的稳定性进行评价。结果观察组手术时长、麻醉复苏时间、出血量和皮瓣切取时间与对照组相比明显减少(均P<0.05);观察组患者满意率、穿支定位准确率、供区与受区血管吻合率明显优于对照组(均P<0.05);观察组不良反应发生率为13.3%(2/15),低于对照组的53.3%(8/15)(P=0.020)。效益指标中,对患者治疗效果影响最大的是供区与受区血管吻合率和皮瓣成活率,风险指标中,影响较大的是静脉危象和皮瓣坏死。观察组的效益-风险值为77,对照组为56,两组相差21(95%CI:14~26),并且在0~100%风险相对权重范围内均高于对照组,表明多准则决策评价模型的稳定性较好。结论CTA三维重建技术可提高游离双叶股前外侧穿支皮瓣移植修复四肢创面的供区与受区血管吻合率及患者满意率。Objective To investigate the efficacy of computed tomographic angiography(CTA)three-dimensional reconstruction technology in the repair of limb wounds using free double-leaf anterolateral thigh perforator flaps.Methods A retrospective analysis was conducted on 30 patients with varying degrees of skin damage on their limbs who were admitted to the Hand and Foot Surgery Department of Yiwu Central Hospital in Zhejiang Province and Zhejiang Provincial People's Hospital from January 2015 to March 2022.The patients were divided into observation group(n=15)and control group(n=15)based on whether CTA three-dimensional reconstruction was performed preoperatively.In the observation group,CTA three-dimensional reconstruction was performed preoperatively,including 9 males and 6 females,aged 17-67(49.7±4.2)years.In the control group,handheld Doppler ultrasound angiography was performed preoperatively,including 10 males and 5 females,aged 20-69(50.4±5.0)years.Relevant intraoperative and postoperative indicators were compared between the two groups,including operation duration,anesthesia recovery time,blood loss,perforator localization accuracy,vascular anastomosis rate between the donor and recipient sites,flap harvesting time,flap survival rate,and incidence of adverse reactions.Follow-up visits were conducted via telephone or outpatient clinic for 3 months postoperatively,with one visit per month,to assess patient satisfaction rates.A multi-criteria decision-making model was established,and the benefit values,risk values,and stability of the decision-making model were evaluated for both groups.Results Compared with the control group,the observation group had significantly reduced operation duration,anesthesia recovery time,blood loss,and flap harvesting time(all P<0.05).The patient satisfaction rate,perforator localization accuracy,and vascular anastomosis rate between the donor and recipient sites were significantly better in the observation group than in the control group(all P<0.05).The incidence of adverse reactions wa

关 键 词：血管造影术 三维重建 股前外侧穿支皮瓣 四肢创面 血管吻合率 

分 类 号：R658.3[医药卫生—外科学]