混合现实技术辅助股前外侧皮瓣穿支血管定位解剖的临床应用

目的探讨混合现实技术定位穿支血管及辅助穿支血管解剖在制取股前外侧皮瓣的临床应用价值。方法收集南充市中心医院口腔颌面外科2020年1月至2021年1月6例口腔颌面部肿瘤切除后需行股前外侧皮瓣修复患者,术前将携带校准点的患者双下肢CT血管成像数据导入数据工作站,对双下肢穿支血管及其周围组织进行三维重建,并将重建结果导入Microsoft Hololens 2眼镜。术中通过术区校准点进行校准,使术前重建结果借助Microsoft Hololens 2眼镜重合投射在术区,从术前是否重建出穿支血管、穿支血管实际走行是否符合重建结果、穿支点实际位置与术前重建结果偏差是否在1 cm内、是否发生穿支血管损伤等方面分析混合现实技术辅助股前外侧穿支皮瓣穿支血管定位解剖的临床应用价值,并记录取瓣所需时间、术中所需校准时间。结果6例患者均在术前顺利重建出穿支血管位置及走行,术中穿支血管实际走行均符合重建结果,穿支点实际位置与术前重建结果偏差均在1 cm内,符合股前外侧皮瓣实际制备要求,所有病例均无穿支血管损伤发生;平均制取皮瓣时间为(70.50±7.20)min;平均校准时间为(13.33±5.50)min;术后皮瓣均存活。结论混合现实技术将股前外侧穿支血管重建结果直接投射在术区,为辅助定位及解剖股前外侧皮瓣穿支血管提供一种新方法,减少了损伤穿支血管的可能性。

Clinical application of the mixed reality technique to assist the location and anatomy of perforator vessels of the anterolateral femoral flap

Objective To explore the clinical application value of mixed reality technology in locating perforator vessels and assisting perforator vessel dissection to harvest anterolateral thigh flaps.Methods Six patients who need?ed anterolateral thigh flap repair after resection of oral and maxillofacial tumors were recruited from the Department of Oral and Maxillofacial Surgery of Nanchong Central Hospital from January 2020 to January 2021.Before surgery,the CT angiography data of the lower limbs of the patients carrying the calibration points were imported into the data work?station to perform 3D reconstruction of the perforator vessels and surrounding tissues of the thigh,and the reconstruc?tion results were imported into Microsoft HoloLens 2 glasses.During the operation,calibration was performed at the cali?bration point of the operative area so that the preoperative reconstruction results were superimposed on the operative ar?ea through Microsoft HoloLens 2 glasses.The clinical application value of mixed reality technology assisted perforator vessel location and anatomy of anterolateral femoral perforator flap was discussed from six aspects:whether the perfora?tor vessel was reconstructed preoperatively,intraoperative calibration time,whether the actual position of the perforating vessels passing through the fascia lata fulcrum deviated from the preoperative reconstruction result within 1 cm,time re?quired to harvest the flap,and whether the actual route of the perforator vessel was consistent with the reconstruction re?sult,and whether the postoperative flap survived.Results The position and course of perforating vessels were success?fully reconstructed in 6 cases before the operation.The actual course of perforating vessels during the operation was con?sistent with the reconstruction results.The deviation between the actual position of the perforating points and the preop?erative reconstruction results was within 1 cm,which met the requirements of the actual asisting of the anterolateral thigh flap.The average time of flap harvest was(70.50±7.20)min.The average calibration time was(13.33±5.50)min.All flaps survived.Conclusions Mixed reality technology projects the reconstruction results of anterolateral femo?ral perforator vessels directly into the operative area,which provides a new method for asisting localization and anatomy of anterolateral femoral flap perforator vessels and reduces the possibility of injury to perforator vessels.