本文關(guān)鍵詞： 逆行 股前外側(cè)皮瓣 CT血管造影 分類　出處：《北京協(xié)和醫(yī)學院》2015年博士論文　論文類型：學位論文

【摘要】：目的：通過分析一系列CT血管造影檢查的結(jié)果,探討逆行股前外側(cè)皮瓣穿支血管的解剖學特點。根據(jù)穿支血管的來源不同,對逆行股前外側(cè)皮瓣進行分類,并探討該分類的臨床意義。介紹一種新的逆行股前內(nèi)側(cè)皮瓣及其在臨床中的應(yīng)用情況。探討術(shù)前CT血管造影檢查對于逆行股前外側(cè)皮瓣切取術(shù)的意義。方法：2012年到2015年,10人接受下肢CT血管造影檢查,對CT血管造影檢查結(jié)果進行全面分析和測量,按照穿支血管的來源不同,將逆行股前外側(cè)皮瓣分為4個類型,1型皮瓣穿支血管來源于降支,2型皮瓣穿支血管來源于斜支,3型皮瓣穿支血管來源于股直肌支,4型皮瓣穿支血管來源于橫支或者由橫支發(fā)出的斜支,分別測量各個類型皮瓣的血管蒂長度并進行比較。介紹有術(shù)前CT血管造影檢查輔助的逆行股前外側(cè)皮瓣切取經(jīng)驗,對術(shù)后皮瓣轉(zhuǎn)歸進行統(tǒng)計分析。結(jié)果：CT血管造影研究共找到穿支血管72支,平均每側(cè)大腿為3.6±0.8支(范圍3至6支)。其中,有39支穿支血管直接來源于降支,有10支穿支血管來源于斜支,有11支穿支血管來源于股直肌支,有12支穿支血管來源于橫支或者由橫支發(fā)出的斜支。1型皮瓣血管蒂平均長度為13.7±4.8厘米(范圍5.4至28.3厘米),2型皮瓣血管蒂平均長度為21.1±2.7厘米(范圍17.5至24.8厘米),3型皮瓣血管蒂平均長度為24.1±4.0厘米(范圍20.9至33.8厘米),4型皮瓣血管蒂平均長度為26.4±3.5厘米(范圍21.4至31.7厘米)。10例臨床病例,共切取逆行股前外側(cè)皮瓣11個,其中1型逆行股前外側(cè)皮瓣4例,2型逆行股前外側(cè)皮瓣4例,3型逆行股前外側(cè)皮瓣2例,4型逆行股前外側(cè)皮瓣1例。皮瓣面積最大為23×13 cm,最小為15×5 cm,皮瓣全部成活,其中完全成活10例,有1例術(shù)后出現(xiàn)皮瓣靜脈回流不暢,經(jīng)對癥處理后皮瓣尖端表皮壞死。術(shù)后隨訪效果均滿意。結(jié)論：逆行股前外側(cè)皮瓣是膝周軟組織缺損修復(fù)可供選擇之一。以穿支來源的不同對逆行股前外側(cè)皮瓣進行分類,結(jié)果顯示2、3、4型血管蒂的長度明顯大于1型。新的分類辦法可為臨床醫(yī)生提供思路,在皮瓣需要更長的血管蒂時,可以考慮切取2、3、4型逆行股前外側(cè)皮瓣。逆行股前內(nèi)側(cè)皮瓣可以作為逆行股前外側(cè)皮瓣的有效替代方案,但該皮瓣的血管解剖存在變異,術(shù)前需行CT血管造影檢查以明確皮瓣的切取是否可行。術(shù)前CT血管造影檢查可以幫助術(shù)者在術(shù)前全面了解旋股外側(cè)動脈系統(tǒng)的血管分支和各分支穿支血管的解剖信息,從而根據(jù)患者的實際情況,選擇更為合理的逆行股前外側(cè)皮瓣切取方式,制定個性化手術(shù)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 鹵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 鹵4.8 cm (range 5.4 to 28.3 cm). The average length of the pedicle was 21.1 鹵2.7 cm (range 17.5 to 24.8 cm). The average length of vascular pedicle of flap was 24.1 鹵4.0 cm (range 20.9 to 33.8 cm). The average length of vascular pedicle was 26.4 鹵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.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R622
，

本文編號：1541979