CAJ | 학술논문

目的探讨在3 D-CTA辅助下第二足趾再造手指设计方案的临床意义. 方法自2010年6月至2013年3月,对5例手指缺损患者在3D-CTA辅助下行第二足趾再造手指术.术前行同侧足及再造手3D-CTA血管三维检查,应用计算机软件初步建立三维数字化模型,将供、受区血管走行、毗邻精准定位,标测、量化血管口径.再造拇指4例,小指1例,均为二期手术；按顾玉东等再造手指缺损分度:拇指为Ⅱ度、Ⅲ度各2例,小指为Ⅴ度1例. 结果本组5例再造指均顺利成活,随访4 ～ 12个月,再造指痛、温觉恢复良好,两点辨别觉5～10 mm,再造指间关节屈曲10°～30°,掌指关节屈曲35°～80°.患者均于术后3个月内恢复正常的行走、负重功能. 结论同侧足及再造手3D-CTA三维数字化模型能客观、真实的反映供、受区血管(有无变异、走行、供受区血管口径)情况,提高手指再造成功率.
목적 탐토재3 D-CTA보조하제이족지재조수지설계방안적림상의의. 방법 자2010년6월지2013년3월,대5례수지결손환자재3D-CTA보조하행제이족지재조수지술.술전행동측족급재조수3D-CTA혈관삼유검사,응용계산궤연건초보건립삼유수자화모형,장공、수구혈관주행、비린정준정위,표측、양화혈관구경.재조무지4례,소지1례,균위이기수술；안고옥동등재조수지결손분도:무지위Ⅱ도、Ⅲ도각2례,소지위Ⅴ도1례. 결과 본조5례재조지균순리성활,수방4 ～ 12개월,재조지통、온각회복량호,량점변별각5～10 mm,재조지간관절굴곡10°～30°,장지관절굴곡35°～80°.환자균우술후3개월내회복정상적행주、부중공능. 결론 동측족급재조수3D-CTA삼유수자화모형능객관、진실적반영공、수구혈관(유무변이、주행、공수구혈관구경)정황,제고수지재조성공솔.
Objective To investigate the clinical significance of the 3D-CTA (three-dimensional computed tomography angiography)assisted design of finger reconstruction the second toe.Methods Between June 2010 and January 2013,five patients with finger defect received 3D-CTA assisted finger reconstruction surgeries using the second toe.Preoperative ipsilateral foot and hand 3D-CTAs were conducted and the 3D digital models were analyzed.The accurate positions and adjacent relations of vessels in both donor and recipient site were precisely marked and then the calibers of the vessels were measured.Four cases received thumb reconstructions and 1 case received little finger reconstruction.All of these surgeries were second-stage.According to Gu Yudong's classification of finger defect:second degree 2 cases,third degree 2 cases,five degree 1 case(little finger).Results With the help of 3D-CTA,five patients in this group had no vascular crisis,and all fingers survived successfully.With 4-12 months' follow-up,the algesthesia and thalposis of the reconstructed fingers gained good recoveries.The two-point discrimination was 5-10 mm.Tthe range of flexion of interphalangeal joint was 10 °-30 °.The range of flexion of the metacarpophalangeal joints was 35 °-80 °.And all patients restored walking and bearing functions with 3 months after surgeries.Conclusion The 3D-CTA reconstruction based digital model of ipsilateral foot and hand can objectively reflect the real situation of the vessels in both donor sites and recipient sites (exist of variations,routes and the calibers of the vessels),thus improve the success rate of surgery.