本文選題：血管化游離腓骨皮瓣　切入點(diǎn)：計(jì)算機(jī)斷層掃描血管造影定位　出處：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:評(píng)價(jià)術(shù)前計(jì)算機(jī)斷層掃描血管造影(computed tomography angiography,CTA)定位的血管化游離腓骨皮瓣(free fibula flap,FFF)在頜骨成釉細(xì)胞瘤(ameloblastoma,AM)術(shù)后缺損重建中的應(yīng)用價(jià)值。方法:回顧性收集2009年1月至2016年11月因頜骨AM行根治性切除同期血管化FFF重建缺損的患者22例,其中15例術(shù)前行下肢CTA定位腓動(dòng)脈及其穿支,排除下肢血管變異或畸形,測(cè)量并統(tǒng)計(jì)腓動(dòng)脈(Peroneal artery,PA)及其穿支的起源、走行、管徑大小等相關(guān)檢查結(jié)果,以術(shù)中解剖探查結(jié)果為金標(biāo)準(zhǔn),對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,從而探討CTA用于腓動(dòng)脈及其穿支術(shù)前評(píng)估的準(zhǔn)確性;同時(shí)術(shù)前利用計(jì)算機(jī)輔助設(shè)計(jì)/計(jì)算機(jī)輔助制作(computer adied designing and computer adied manufacturing,CAD/CAM)模擬頜骨切除與重建,制作患者個(gè)性化頜骨模型及手術(shù)導(dǎo)板,對(duì)其同期行FFF重建。術(shù)后隨訪時(shí)間為6個(gè)月-5年,通過(guò)臨床復(fù)查,電話隨訪,影像學(xué)檢查,患者主觀等級(jí)評(píng)價(jià)等方法,了解術(shù)后受區(qū)及供區(qū)功能美觀等情況。結(jié)果:(1)本組22例FFF術(shù)后全部成活,存活率100%,移植的腓骨段長(zhǎng)度7.5-21.5cm,平均長(zhǎng)度為13.4cm,其中4例攜帶皮島,皮島大小分別為3.O×5.0cm、3.O×4.0cm、3.5×4.5cm、6.5×3.0cm。隨訪期間,除6例(27.3%)出現(xiàn)小腿功能減退外,其余患者受區(qū)形態(tài)、咬合關(guān)系及功能均較為理想,術(shù)后復(fù)查三維CT,顯示受區(qū)鈦板鈦釘固位良好,移植骨斷端與下頜骨殘端結(jié)合良好,重建的下頜骨形態(tài)基本與健側(cè)對(duì)稱。(2)本研究15例CTA共檢測(cè)到30側(cè)(左側(cè)15例,右側(cè)15例)腓動(dòng)脈,檢出率為100%。PA起始處外徑為4.41±0.81mm,PA起始處至腓骨頭(Fibulahead,FA)外側(cè)尖的垂直距離為41.91±6.59mm,穿支起始處至FA外側(cè)的垂直距離為79.06±17.56mm。PA起始處管徑與年齡、性別均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。15例PA共檢測(cè)到穿支27支,其中5例(33%)穿支為1支,6例(40%)穿支為2支,3例(20%)穿支為3支,1例(7%)未顯示分支;在27例穿支中,肌間隙(myocutaneous perforator,MP)穿支共 17 支(62.96%),皮支(septocutaneous perforator,SP)共 10 支(37.03%)。術(shù)前 CTA 顯示 PA 起源Ⅰ型有 13 例(86.7%),Ⅱ型 1 例(6.7%),Ⅳ型1例(6.6%)。術(shù)中解剖探查發(fā)現(xiàn)15例中PA起源Ⅰ型者12例(80%),Ⅱ者1例(6.6%),Ⅳ型者2例(13.4%)。在PA起源類型方面,CTA檢查結(jié)果與術(shù)中解剖結(jié)果無(wú)明顯統(tǒng)計(jì)學(xué)差異;以術(shù)中探查有無(wú)腓動(dòng)脈穿支為金標(biāo)準(zhǔn),CTA檢測(cè)穿支血管有無(wú)的準(zhǔn)確率為80%,敏感度為86.7%,與術(shù)中探查相比無(wú)顯著性差異(P0.05)。結(jié)論:(1)頜骨成釉細(xì)胞瘤因其具有局部侵襲性及浸潤(rùn)性生長(zhǎng)的特點(diǎn),術(shù)后易復(fù)發(fā)。臨床上應(yīng)根據(jù)AM臨床病理類型、年齡、病程等綜合考慮選擇治療手段,術(shù)后應(yīng)密切隨訪觀察。(2)游離腓骨皮瓣骨量足骨質(zhì)高、可根據(jù)頜面部缺損大小形態(tài)進(jìn)行截骨塑性,具有血供充足、抗感染能力強(qiáng)以及成骨愈合快等優(yōu)點(diǎn),是目前成釉細(xì)胞瘤根治性切除術(shù)后頜骨及軟組織缺損重建較為理想的方法。(3)術(shù)前CTA可較為準(zhǔn)確地顯示腓動(dòng)脈及其穿支的起源、走行等情況,排除下肢血管解剖變異及病變,對(duì)術(shù)前設(shè)計(jì)游離腓骨肌皮瓣具有一定的指導(dǎo)意義。但CTA在腓動(dòng)脈及其穿支管徑及類型方面的準(zhǔn)確性有待進(jìn)一步研究。
[Abstract]:Objective : To evaluate the clinical value of computed tomography angiography ( CTA ) in the reconstruction of the defect after operation . The results showed that : ( 1 ) All the 22 patients with FFF underwent resection and reconstruction of mandible . The results showed that : ( 1 ) All the 22 cases of FFF were treated by computer - aided design / computer - aided manufacturing ( CAD / CAM ) . The results were as follows : ( 1 ) All the 22 cases were treated by computer - aided design / computer - aided manufacturing ( CAD / CAM ) . The results showed that the length of the graft was 3 . 0 脳 5.0 cm , 3 . 0 脳 4.0cm , 3.5 脳 4.5 cm , 6.5 脳 3.0 cm , and the length of the graft was 3 . 0 脳 5 . 0 cm , 3 . 0 脳 4.0cm , 3.5 脳 4.5 cm , 6.5 脳 3.0 cm . In addition , 6 cases ( 27.3 % ) had lower leg function , and the other patients were divided into three - dimensional CT , which showed good fixation of Ti - Ti - Ti - Ti - Ti - Ti - Ti - Ti - Ti - Ti - Ti - Ti fixation , and the reconstructed mandible was basically symmetrical with the healthy side . Results : There were 13 cases ( 86 . 7 % ) , 1 ( 6 . 7 % ) of PA origin and 2 ( 13.6 % ) of 鈪，

本文編號(hào)：1668305