小腿后部穿支的3D可视化研究与皮瓣设计

目的：运用血管造影及其数字化模型探讨小腿后部各区穿支间的关系,为穿支皮瓣的临床应用提供解剖学依据。方法：（1）8具新鲜成人整尸,采用改良的氧化铅配方行一次性全身动脉造影。其中2具行连续螺旋CT扫描,对小腿进行三维重建。（2）将小腿后部分为上、中、下3区,层次解剖并配合x线摄影,观测各区穿支的定位、直径、走行、分支及其相互之间的吻合状况。结果：小腿后部共有外径≥0．5mm穿支（13±2．3）支,平均外径（0．8±0．2）mm,平均供血面积（38±9．0）cm2。上区的胭动脉穿支位置恒定且较粗大,向下与中区的胫后动脉、腓动脉之穿支形成不减少口径的真性吻合,其单穿支供血面积高达（55±20）cm2;下区穿支较细,沿跟腱两侧呈链状分布,向上与中区的穿支吻合。结论：小腿后部为良好的穿支皮瓣供区,中区可切取穿支皮瓣游离移植,上区与下区可分别切取近端蒂与远端蒂穿支皮瓣。     

新鲜全血在多台血细胞分析仪校准中的应用

目的:探讨新鲜全血用于多台血细胞分析仪校准的可行性.方法:以SYSMEX K-4500血细胞分析仪作为参考比对仪器,应用新鲜全血对迈瑞BC-1800及MS-9血细胞分析仪进行校准.每日选取3个标本(高值、中值及低值各1个)进行比对试验,监测仪器稳定性及结果准确度,根据监测结果校准仪器.结果:对迈瑞BC-1800及MS-9血细胞分析仪部分指标系数进行调整后,3台血细胞分析仪结果具有可比性,在临床可相互替换使用.结论:新鲜全血用于多台血细胞分析仪的校准是一种经济、可靠的方法,应用该方法可提高同一实验室不同仪器之间检测结果的准确性和一致性.     

迈瑞BC-5500全自动血细胞分析仪应用评价

目的:初步评价迈瑞BC-5500全自动血细胞分析仪主要性能的可靠性.方法:按照国际血液学标准化委员会的有关规定对迈瑞BC-5500全自动血细胞分析仪进行测试,从精密度、携带污染率、线性及与SYSMEX XE-2100全自动血细胞分析仪相关性等进行评价.结果:迈瑞BC-5500全自动血细胞分析仪的批内、批间精密度及总精密度变异系数(CV)值均在可接受范围内;各分析参数的携带污染率均小于0.5%.线性良好;与SYSMEX XE-2100全自动血细胞分析仪对比分析,各研究参数相关性良好.结论:迈瑞BC-5500全自动血细胞分析性能优良,检测结果准确、可靠.     

小腿后部各区穿支间的关系与皮瓣设计

Objective To study the anastomotic relationships of perforators in each zone of the poste-rior leg and design perforating flaps for clinic. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. The posterior part of leg is divided into upper, mid-die and below equal parts, Observe topography of the perforating branches in every district by layer, and mea-sured their location, diameter, course, branches and anastomosis pattern. Radiographs of tissue specimens were digitally analyzed. Results There were 13 perforators that diameter≥ 0.5 mm, the average external diameter was 0.8 mm. The areas of each perforator supplied was average 38 cm2. Perforators from popliteal artery was identified an area 4 cm wide, around the intersection of two lines, a line drawn between the medial and lateral epicondyles of the femurs, and the midline of posterior leg. The areas of the every perforator sup-plied was 55 cm2. These vessels were large in diameter and create multiple true anastomoses with the perfora-tors from the posterior tibial artery or fibular artery. Perforating branches were small in the below part, a long perforator chain comprised of two to three perforators accompanies the Achilles tendon. Conclusion The perforator flaps deviced by perforators from the posterior leg may be transplanted to the lower limbs and the other part of the body. The perforators located in the middle zone of the leg are larger. Free posterior tibial or peroneal perforator-based flaps are reliable, relatively large, and have thin flaps. The upper and lower zones were the larger donor site for the proximal or distally pedicled perforator flap harvest.     

数字化与虚拟现实技术在皮瓣移植中的应用

目的研究数字化与虚拟现实技术在股前外侧皮瓣解剖设计与可视化中的应用。方法①应用“虚拟中国人”男性3号数据集,在薄层断面图像上观察旋股外侧动脉的主要解剖结构,应用Amira 3．1 (TGS)软件对股前外侧皮瓣结构进行计算机三维重建并立体显示。②明胶一氧化铅混悬液灌注的新鲜成人下肢标本1具,行连续螺旋CT扫描,观测旋股外侧动脉分布及彼此间的吻合情况,应用Amira 3．1软件对股前外侧皮瓣结构进行计算机三维重建并立体显示。结果重建的数字化模型可准确反映股前外侧皮瓣的解剖学结构特点。结论重建的图像可以提供正常股前外侧皮瓣三维动态解剖,为临床教学术前皮瓣设计提供了直观的数字化解剖依据；同时可为下一步虚拟手术的设计奠定良好的基础。     

小腿后部各区穿支间的关系与皮瓣设计

Objective To study the anastomotic relationships of perforators in each zone of the poste-rior leg and design perforating flaps for clinic. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. The posterior part of leg is divided into upper, mid-die and below equal parts, Observe topography of the perforating branches in every district by layer, and mea-sured their location, diameter, course, branches and anastomosis pattern. Radiographs of tissue specimens were digitally analyzed. Results There were 13 perforators that diameter≥ 0.5 mm, the average external diameter was 0.8 mm. The areas of each perforator supplied was average 38 cm2. Perforators from popliteal artery was identified an area 4 cm wide, around the intersection of two lines, a line drawn between the medial and lateral epicondyles of the femurs, and the midline of posterior leg. The areas of the every perforator sup-plied was 55 cm2. These vessels were large in diameter and create multiple true anastomoses with the perfora-tors from the posterior tibial artery or fibular artery. Perforating branches were small in the below part, a long perforator chain comprised of two to three perforators accompanies the Achilles tendon. Conclusion The perforator flaps deviced by perforators from the posterior leg may be transplanted to the lower limbs and the other part of the body. The perforators located in the middle zone of the leg are larger. Free posterior tibial or peroneal perforator-based flaps are reliable, relatively large, and have thin flaps. The upper and lower zones were the larger donor site for the proximal or distally pedicled perforator flap harvest.     

小腿后部各区穿支间的关系与皮瓣设计

Objective To study the anastomotic relationships of perforators in each zone of the poste-rior leg and design perforating flaps for clinic. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. The posterior part of leg is divided into upper, mid-die and below equal parts, Observe topography of the perforating branches in every district by layer, and mea-sured their location, diameter, course, branches and anastomosis pattern. Radiographs of tissue specimens were digitally analyzed. Results There were 13 perforators that diameter≥ 0.5 mm, the average external diameter was 0.8 mm. The areas of each perforator supplied was average 38 cm2. Perforators from popliteal artery was identified an area 4 cm wide, around the intersection of two lines, a line drawn between the medial and lateral epicondyles of the femurs, and the midline of posterior leg. The areas of the every perforator sup-plied was 55 cm2. These vessels were large in diameter and create multiple true anastomoses with the perfora-tors from the posterior tibial artery or fibular artery. Perforating branches were small in the below part, a long perforator chain comprised of two to three perforators accompanies the Achilles tendon. Conclusion The perforator flaps deviced by perforators from the posterior leg may be transplanted to the lower limbs and the other part of the body. The perforators located in the middle zone of the leg are larger. Free posterior tibial or peroneal perforator-based flaps are reliable, relatively large, and have thin flaps. The upper and lower zones were the larger donor site for the proximal or distally pedicled perforator flap harvest.     

小腿后部各区穿支间的关系与皮瓣设计

Objective To study the anastomotic relationships of perforators in each zone of the poste-rior leg and design perforating flaps for clinic. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. The posterior part of leg is divided into upper, mid-die and below equal parts, Observe topography of the perforating branches in every district by layer, and mea-sured their location, diameter, course, branches and anastomosis pattern. Radiographs of tissue specimens were digitally analyzed. Results There were 13 perforators that diameter≥ 0.5 mm, the average external diameter was 0.8 mm. The areas of each perforator supplied was average 38 cm2. Perforators from popliteal artery was identified an area 4 cm wide, around the intersection of two lines, a line drawn between the medial and lateral epicondyles of the femurs, and the midline of posterior leg. The areas of the every perforator sup-plied was 55 cm2. These vessels were large in diameter and create multiple true anastomoses with the perfora-tors from the posterior tibial artery or fibular artery. Perforating branches were small in the below part, a long perforator chain comprised of two to three perforators accompanies the Achilles tendon. Conclusion The perforator flaps deviced by perforators from the posterior leg may be transplanted to the lower limbs and the other part of the body. The perforators located in the middle zone of the leg are larger. Free posterior tibial or peroneal perforator-based flaps are reliable, relatively large, and have thin flaps. The upper and lower zones were the larger donor site for the proximal or distally pedicled perforator flap harvest.     

腓骨肌腱鞘筋膜瓣与脂肪筋膜瓣联合移植修复足跟后深层组织缺损的解剖与应用

目的 为腓骨肌腱鞘筋膜瓣与脂肪筋膜瓣联合移植修复足跟后深层组织缺损提供应用解剖学基础.方法 ①5具(10侧)动脉灌注红色乳胶成人下肢防腐标本,解剖观测腓骨肌腱鞘筋膜及相邻脂肪筋膜血供的来源,测垦其血管管径及其走行、分支与分布情况.②8具(16侧)全身动脉灌注氧化铅一明胶混悬液的新鲜成人整尸标本,解剖下肢筋膜层组织,并取下拍摄X线片,观察腓骨肌腱鞘筋膜层与相邻脂肪筋膜层之间的血供及交通吻合情况.③将2具(4侧)下肢标本构建血管铸型图,直观地了解瓣区血管的走行、分布、吻合情况.并于临床应用了8例.结果 根据腓骨肌腱鞘的长度范围,重点观察了自外踝尖下4 cm至外踝尖上14 cm区域内腓骨肌腱鞘筋膜与相邻脂肪筋膜较为粗大的供血血管,联合筋膜瓣血供呈多源性分布:外踝尖上下4 cm瓣区主要有跟外侧动脉恒定发出3.7(2～5)支,外径(0.5±0.2)mm;外踝后动脉发出1.5(1～2)支,外径(0.6±0.2)mm;腓动脉穿支降支发出2.5(2～3)支,外径(0.5±0.2)mm.外踝尖4 cm以上腓骨肌腱鞘及相邻脂肪筋膜主要由腓动脉发出肌间隔支发出1.7(1～3)支,外径(1.0±0.2)mm以及腓动脉穿支升支的细小分支营养.以上各动脉支在腱周组织内恒定吻合,并发出多数细小分支构筑筋膜层丰富血管网.临床应用的8例术后转移筋膜瓣、移植皮片完全存活.随访3个月至2年,供、受区愈合良好,功能形态恢复满意.结论 可以上述血管之一为蒂,设计切取近端蒂携带腓骨肌腱鞘、滑筋膜瓣或逆行远端蒂携带脂肪筋膜、肌腱鞘筋膜瓣,联合修复小腿下段及足跟后难愈性中小面积缺损.     

小腿外侧穿支皮瓣的解剖与临床应用

目的 通过解剖学研究,分析腓动脉穿支特点,评价其临床应用的可行性. 方法 通过解剖40侧新鲜小腿标本,使用明胶氧化铅灌注技术,行一次性全身动脉造影、容积螺旋CT扫描,构建三维可视化模型,重点观察小腿.解剖后统计小腿外侧穿支出现数量、穿出位置、各穿支的管径、血管蒂的长度,归纳其规律性.针对2005年7月至2009年10月的43例中等面积的手、足皮肤缺损进行了游离腓动脉穿支皮瓣移植修复手术,并统计成活率,术后就外观和功能随访6个月到2年.结果 小腿外侧腓动脉穿支为2～9支,平均4支,在腓骨小头下方(9.80±0.93)cm、(13.40±0.90)cm、(17.20±1.13)cm、(21.30±0.77)cm四处出现率较高,动脉穿支直径分别为(1.33±0.39)mm、( 1.30±0.46)mm、(1.17±0.30)mm、(1.22±0.23)mm,血管蒂长分别为(5.87±0.73)cm、(5.83±1.73)cm、(5.44±1.09)cm,(5.10±1.93)cm.临床应用43例游离腓动脉穿支皮瓣,成活42例,1例皮瓣坏死.所有病例随访6个月到2年,皮瓣术后外观满意36例,术后臃肿需要二期修整的7例.供区小腿外观、功能均正常.结论腓动脉有四处穿支出现基本恒定,其中小腿中1/3段的穿支血管(第2、3条穿支)管径较粗,蒂长度5～7cm,适合进行游离皮瓣设计.