逆行股前外侧皮瓣的CT血管成像研究

发布时间：2018-02-27 08:50

  本文关键词： 逆行 股前外侧皮瓣 CT血管造影 分类　出处：《北京协和医学院》2015年博士论文　论文类型：学位论文

【摘要】：目的：通过分析一系列CT血管造影检查的结果,探讨逆行股前外侧皮瓣穿支血管的解剖学特点。根据穿支血管的来源不同,对逆行股前外侧皮瓣进行分类,并探讨该分类的临床意义。介绍一种新的逆行股前内侧皮瓣及其在临床中的应用情况。探讨术前CT血管造影检查对于逆行股前外侧皮瓣切取术的意义。方法：2012年到2015年,10人接受下肢CT血管造影检查,对CT血管造影检查结果进行全面分析和测量,按照穿支血管的来源不同,将逆行股前外侧皮瓣分为4个类型,1型皮瓣穿支血管来源于降支,2型皮瓣穿支血管来源于斜支,3型皮瓣穿支血管来源于股直肌支,4型皮瓣穿支血管来源于横支或者由横支发出的斜支,分别测量各个类型皮瓣的血管蒂长度并进行比较。介绍有术前CT血管造影检查辅助的逆行股前外侧皮瓣切取经验,对术后皮瓣转归进行统计分析。结果：CT血管造影研究共找到穿支血管72支,平均每侧大腿为3.6±0.8支(范围3至6支)。其中,有39支穿支血管直接来源于降支,有10支穿支血管来源于斜支,有11支穿支血管来源于股直肌支,有12支穿支血管来源于横支或者由横支发出的斜支。1型皮瓣血管蒂平均长度为13.7±4.8厘米(范围5.4至28.3厘米),2型皮瓣血管蒂平均长度为21.1±2.7厘米(范围17.5至24.8厘米),3型皮瓣血管蒂平均长度为24.1±4.0厘米(范围20.9至33.8厘米),4型皮瓣血管蒂平均长度为26.4±3.5厘米(范围21.4至31.7厘米)。10例临床病例,共切取逆行股前外侧皮瓣11个,其中1型逆行股前外侧皮瓣4例,2型逆行股前外侧皮瓣4例,3型逆行股前外侧皮瓣2例,4型逆行股前外侧皮瓣1例。皮瓣面积最大为23×13 cm,最小为15×5 cm,皮瓣全部成活,其中完全成活10例,有1例术后出现皮瓣静脉回流不畅,经对症处理后皮瓣尖端表皮坏死。术后随访效果均满意。结论：逆行股前外侧皮瓣是膝周软组织缺损修复可供选择之一。以穿支来源的不同对逆行股前外侧皮瓣进行分类,结果显示2、3、4型血管蒂的长度明显大于1型。新的分类办法可为临床医生提供思路,在皮瓣需要更长的血管蒂时,可以考虑切取2、3、4型逆行股前外侧皮瓣。逆行股前内侧皮瓣可以作为逆行股前外侧皮瓣的有效替代方案,但该皮瓣的血管解剖存在变异,术前需行CT血管造影检查以明确皮瓣的切取是否可行。术前CT血管造影检查可以帮助术者在术前全面了解旋股外侧动脉系统的血管分支和各分支穿支血管的解剖信息,从而根据患者的实际情况,选择更为合理的逆行股前外侧皮瓣切取方式,制定个性化手术方案。
[Abstract]:Objective: to study the anatomical characteristics of perforating branch of retrograde anterolateral femoral flap by analyzing the results of a series of CT angiography. The retrograde anterolateral femoral flap was classified according to the origin of perforating vessel. The clinical significance of this classification was discussed. A new retrograde anteromedial femoral flap and its clinical application were introduced. The significance of preoperative CT angiography for retrograde anterolateral femoral flap resection was discussed. Methods: 2012. By 2015, 10 patients had undergone lower extremity CT angiography, The results of CT angiography were analyzed and measured according to the origin of perforating vessels. The retrograde anterolateral femoral flap was divided into four types: the perforating branch of 1 type flap originated from the perforating branch of the descending branch 2 flap and the perforating branch of the type 3 flap originated from the transverse branch or the transverse branch of the 4 type flap of the rectus femoris branch. The oblique branch from the transverse branch, The length of vascular pedicle of each type of flap was measured and compared. The experience of retrograde anterolateral thigh flap assisted by CT angiography was introduced. Results A total of 72 perforating vessels (3.6 卤0.8 branches per thigh) were found in the study of circumferential CT angiography (range 3 to 6 branches). Among them, 39 perforators were directly derived from descending branches. Ten perforating vessels come from the oblique branches, and 11 from the rectus femoris branches. The average length of the pedicle of the 1 type oblique branch flap derived from the transverse branch or from the transverse branch was 13.7 卤4.8 cm (range 5.4 to 28.3 cm). The average length of the pedicle was 21.1 卤2.7 cm (range 17.5 to 24.8 cm). The average length of vascular pedicle of flap was 24.1 卤4.0 cm (range 20.9 to 33.8 cm). The average length of vascular pedicle was 26.4 卤3.5 cm (range 21.4 to 31.7 cm) in 10 cases. A total of 11 retrograde anterolateral femoral flaps were removed. There were 4 cases of retrograde anterolateral femoral flap of type 1 and 4 cases of retrograde anterolateral femoral flap of type 2 and retrograde anterolateral femoral flap of type 3 in 2 cases. The maximum area of the flap was 23 脳 13 cm and the minimum was 15 脳 5 cm. All the flaps survived. Among them, 10 cases survived completely, and 1 case had bad venous drainage after operation. The epidermal necrosis of the tip of the flap was treated with symptomatic treatment. The results of follow-up were satisfactory. Conclusion: the retrograde anterolateral femoral flap is one of the options for repairing perigenicular soft tissue defect. The retrograde anterolateral femoral flap is classified according to the origin of perforating branch. The results showed that the length of vascular pedicle of type 2, 3 and 4 was significantly longer than that of type 1. The new classification method could provide a way for clinicians, when the flap needed a longer pedicle, The retrograde anterolateral femoral flap can be used as an effective alternative to the retrograde anterolateral femoral flap, but the vascular anatomy of the flap is variable. Ct angiography should be performed before operation to determine the feasibility of cutting the flap. The preoperative CT angiography can help the operator to fully understand the vascular branches of the lateral circumflex femoral artery system and the anatomic information of the perforating branches of each branch before the operation. According to the actual situation of the patients, a more reasonable method of retrograde anterolateral thigh flap was selected and individualized operation was made.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R622
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本文编号：1541979