数字化血管三维模型对烧伤患者面部修复术术后皮瓣存活的影响

目的:探讨数字化血管三维模型对烧伤患者面部修复术术后皮瓣存活的影响。方法:选择2012年4月至2017年4月在我院接受组织瓣转移面部修复术的烧伤患者146例,分为对照组(n=64)和研究组(n=82)。对照组术前采用超声多普勒探测患者供区皮瓣的血管位置,走向并标记探测结果,根据多普勒探测结果结合术前设计行皮瓣转移术。观察组术前3~5 d采用CTA技术检查患者供区皮瓣面部受区血管位置、血管走向等,将检查结果通过计算机进行血管三维重建,根据皮瓣血管与受区血管重建模型修订手术方案后行皮瓣转移术。观察和比较手术时间、术后感染发生率、皮瓣断蒂时间、皮瓣血运障碍发生率和术后皮瓣坏死率。结果:研究组手术时间显著短于对照组(P0.01),两组术后感染发生率分别为7.81%和1.21%,研究组明显低于对照组(P0.01)。研究组的皮瓣断蒂时间为17.1±2.5 d,明显短于对照组(21.3±2.8 d,P0.01);对照组皮瓣血运障碍发生率为17.19%,研究组并未发现血运障碍病例。对照组术后皮瓣坏死率为7.81%,而研究组未出现皮瓣坏死病例,存活率为100%,明显高于对照组(P0.05)。结论:术前数字化血管三维模型的建立用于烧伤患者面部修复术可缩短手术时间,提高手术效率,降低术后皮瓣供血障碍的发生率及皮瓣死亡率,有利于患者术后恢复。

Effect of Digital Vascular 3D Model on Flap Survival after Facial Reconstruction in Burn Patients

ABSTRACT Objective: To investigate the effect of digital vascular 3D model on the flap survival after facial reconstruction in burn patients. Methods: A total of 146 cases of burn patients who were treated by tissue flap transfer facial prosthesis from April 2012 to April 2017 were selected and divided into the control group (n=64) and the study group (n=82). In the control group, ultrasound doppler was used to detect the vascular position of flap in the area of skin flap. The observation group of patients was given CTA technology for facial area flap by area, blood vessels, blood vessel position towards, etc 3~5 d preoperativon, 3D reconstruction results were got through the computer''s blood vessels, the blood vessels and the vessels according to flap reconstruction model revision surgery after flap transfer op- eration. The time of operation, the incidence of postoperative infection, the time of the skin flap, the incidence of blood transport disor- der, and the necrosis rate of skin flap after operation were observe and compared between two groups. Results: The operation time of study group was significantly shorter than that of the control group (P<0.01), the incidence rate of postoperative infection of study group and control group were 7.81% and 1.21% , which was significantly lower in the study group than that of the control group (P<0.01). The flap pedicle breaking time of study group was 17.1±2.5 d, which was significantly shorter than that of the control group (21.3±2.8 d, P<0.01); The incidence rate of flap blood circulation disorder of the control group was 17.19%, while none was found in the study group. The flap necrosis rate of control group was 7.81%, while there was no necrosis case in the study group, the survival rate was 100%, which was significantly higher than the control group(P<0.05). Conclusion: Preoperative blood vessel 3D digital model can shorten op- eration time, improve operation efficiency, reduce the postoperative mortality , the incidence rate of skin flap blood disorders of burn pa- tients with facial prosthesisa and flap is beneficial to patients with postoperative recovery.