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目的探讨基于CT血管造影(CT angiography,CTA)的胸背动脉数字化解剖及应用价值。方法选取2012年9月-2014年6月行主动脉CTA并符合选择标准的10例患者(20侧)主动脉CTA图像,利用Mimics17.0三维重建软件进行图像后处理,观察并测量胸背动脉起源、穿支数量、分型、内径、蒂长,并行穿支血管的体表定位以及模拟胸背动脉穿支组织瓣切取。结果三维重建图像显示10例患者胸背动脉均起源于肩胛下动脉,共发现穿支血管76支,其中32支(42.1%)来自胸背动脉内侧支,44支(57.9%)来自胸背动脉外侧支。69支(90.8%)胸背动脉穿支属肌皮穿支型,7支(9.2%)为直接皮动脉型。胸背动脉内径(1.69±0.23)mm、蒂长(2.12±0.64)cm。胸背动脉外侧第1穿支位于肩胛下角水平线上方(1.65±0.42)cm、肩胛下角垂直线外侧(1.68±0.31)cm;内侧第1穿支位于肩胛下角水平线上方(1.43±0.28)cm,肩胛下角垂直线外侧(1.41±0.28)cm。成功模拟胸背动脉穿支组织瓣切取。结论 CTA是在体研究胸背动脉解剖较直观的方法,三维重建后可清晰显示皮瓣的主要供血动脉走行和分布等三维立体信息,能有效、准确指导皮瓣设计。
Objective To investigate the digital anatomy and clinical value of thoracodorsal artery based on CT angiography (CTA). Methods Aorta CTA images of 10 patients (20 sides) who underwent CTA and met the selection criteria from September 2012 to June 2014 were retrospectively analyzed by using Mimics17.0 3D reconstruction software. The thoracodorsal artery Origin, the number of perforating branches, typing, diameter, pedicle length, parallel to the surface of the vessel through the blood vessels and to simulate thoracodorsal artery perforating tissue flap. Results Three-dimensional reconstruction images showed that all thoracodorsal arteries originated from the subscapular artery in 10 patients. A total of 76 perforating vessels were found, of which 32 (42.1%) were from the medial branch of the thoracic dorsal artery and 44 (57.9%) were from the dorsal artery Lateral branch. 69 (90.8%) thoracic and dorsal arterial perforators were perforator type and 7 (9.2%) were direct percutaneous arterial type. Thoracodorsal artery diameter (1.69 ± 0.23) mm, pedicle length (2.12 ± 0.64) cm. The first perforating branch of lateral thoracodorsal artery was located above the level of subscapular angle (1.65 ± 0.42) cm and outside of vertical line of subscapular angle (1.68 ± 0.31) cm. The first perforating branch of medial was located above the level of subscapular angle (1.43 ± 0.28) cm, Outside the lower vertical line (1.41 ± 0.28) cm. Successfully simulated thoracodorsal artery perforating tissue flap cut. Conclusion CTA is an intuitive method to study the anatomy of the thoracodorsal arteries. After three-dimensional reconstruction, three-dimensional information such as the running and distribution of the main feeding arteries can be clearly displayed, which can effectively and accurately guide the flap design.