三维重建技术在髂骨瓣临床手术中的初步应用

目的 探讨三维重建技术在髂骨瓣临床手术中的初步应用. 方法 2006年12月至2008年6月,采用旋髂深血管支髂骨瓣对1例股骨骨不连和5例胫骨骨缺损或骨不连的患者进行骨缺损修复.术前注射造影剂后采用CT扫描,应用Amira4.0软件对髂骨瓣结构进行三维重建,构建患者个性化骨瓣.根据患者骨缺损大小,进行个性化骨瓣三维构建,对患者进行髂骨瓣的点、线、面描记,用以指导手术切取. 结果三维重建患者个性化骨瓣6个,所重建个件化髂骨瓣能够清晰显示血管、骨骼及其毗邻结构的三维关系.6例患者所显示的骨瓣主要血供主干都与术中检查相符.术前测量旋髂深动脉起点距髂前上棘平均4.28 cm,旋髂深动脉主干血管外径平均为2.4 mm,穿支血管数平均为3条.术后6例患者获6个月～2年1个月(平均1年3个月)随访,髂骨瓣全部成活且Ⅰ期愈合,术后3～5个月均达到骨性愈合. 结论通过血管造影下肢CT扫描,采用数字化三维重建技术可以提供髂骨瓣的三维动态解剖,重建的组织瓣能够准确地标示术中切取范围,避免了术中血管的副损伤,保证了髂骨瓣良好的存活率.

Clinical application of three-dimensional reconstruction of ilium bone flap

Objective To discuss an initial clinical application of three-dimensional reconstruction of ilium bone flap. Methods From December 2006 to June 2008, bone defects of 6 patients with frac-tures of femoral shaft and tibia were repaired using vascularized iliac bone flap. After injection of contrast a-gent, CT scan was performed. Amira 4.0 Software was applied to reconstruct personalized three-dimensional structures of the iliac bone flap. The points, lines, and surfaces were marked in the personalized three-dimensional images reconstructed to provide guidance for the actual surgery. Results The person-alized three-dimensional reconstruction of iliac bone flap for the 6 individual patients were successfully used in the actual surgery. The three-dimensional structures of blood vessels, bone and adjacent relationship which had been clearly shown in the reconstructed flaps were confirmed by the actual surgical findings. All the 6 lilac bone flaps survived uneventfully. Conclusion The preoperative three-dimensional reconstruction of lilac bone flap by CT scan, angiography and digital technology can provide a useful aid for actual surgical design and harvest of the flap, minimizing intraoperative injury to blood vessels and enhancing flap survival.