彩色多普勒血流成像技术在低旋转点腓肠神经营养血管皮瓣移植中的临床应用

摘要

目的:应用高分辨率彩色多普勒血流成像技术(CDFI)对外踝后间隙内腓动脉穿支的分布情况、血管口径及血流动力学参数进行研究,为术前评估血管质量及低旋转点腓肠神经营养血管皮瓣的设计提供依据.方法:应用高分辨率彩色多普勒超声对9例患者行外踝后间隙内腓动脉穿支进行检测,统计距外踝尖上0～3 cm范围内起始管径≥0.5 mm腓动脉穿支血管的数目、起始处内径以及血流动力学参数,标记穿出深筋膜位置,并实施低旋转点腓肠神经营养血管皮瓣移植术.结果:共检出穿动脉总数22支,穿支起始处内径为(0.78±0.23)mm,穿出筋膜位置距外踝尖上(1.66±0.91)cm,收缩期血流峰值(0.19±0.03)m/s.术中见腓动脉穿支穿出深筋膜位置、走行方向与术前体表定位完全吻合,皮瓣完全成活.结论:CDFI可以直观地显示外踝后间隙内腓动脉穿支的分布情况、血管口径、血流状态,并能在体表准确定位,可用于术前评价穿支血管质量,为低旋转点腓肠神经营养血管皮瓣的设计提供可靠依据.%Objective: To study the distribution of peroneal artery of lateral post-clearance and vascular diameter and hemodynamic parameters by high-resolution color Doppler flow imaging (CDFI) provides a basis of the preoperative evaluation of vascular quality and the design of low-rotation point sural neurovascular flap. Methods: A total of 9 cases patients were collected for this study from December 2009 to March 2011, each case was detected the number of perforating branches of the peroneal artery, the beginning of diameter and hemodynamic parameters which the initial diameter is bigger than 0. 5 mm and the range is 0 to 3 cm from the lateral tip, then mark the location of where it pierces the deep fascia and implement the operation of low-rotation point sural neurovascular flap graft. Results:Twenty-two perforating arteries were recorded,initial diameter of perforating arteries were (0.78 ±0. 23) mm, the length of the piercing point from deep fascia to the lateral tip was( 1. 66 ± 0. 91) cm, the vascular flow peak systolic velocity was (0. 19 ± 0. 03 ) m/s. The location of the perforating point from deep fascia and traveling direction were completely anastomosised with preoperative positioning of the body surface. All flaps survived completely. Conclusions: CDFI can show the distribution of peroneal artery of lateral post gap and vascular diameter and hemodynamic condition and can accurately locate the surface positioning, which can be used for preoperative evaluation of the quality of perforating branches of blood vessels and provide scientific basis for the design of low-rotation point of sural neurovascular flap.