滑车上动脉的影像学研究及在鼻再造术中的应用

目的通过颈内、外动脉造影对滑车上动脉分支血管进行影像学研究,并设计改良额部皮瓣行鼻再造术。方法选用30例成人颈内、外动脉造影资料进行血管三维成像,对滑车上动脉分支(肌支和皮支)进行研究,探讨滑车上动脉分支走行、层次以及与眶上动脉的交通情况。根据影像学检测结果临床应用滑车上动脉分支设计额部皮瓣对11例鼻缺损患者行鼻再造术。其中男7例,女4例;年龄15～48岁,平均23岁。鼻缺损范围3.0 cm×2.5 cm～5.0 cm×3.5 cm。结果颈内动脉造影和三维成像显示,30例滑车上动脉恒定出现,直径(0.9±0.6)mm;其中浅层皮支恒定出现,直径(0.7±0.3)mm;深层肌支4例缺失,直径(0.5±0.5)mm,走行于额肌间,长(32.0±6.2)mm,分支间互有交通并与眶上动脉亦有吻合。临床应用皮瓣均成活,无软骨外露,外形良好。术后经4个月～3年随访,鼻尖、鼻翼及鼻小柱外形接近正常,鼻高度和坡度适中,再造鼻质地弹性良好,鼻孔无狭窄,通气功能正常。结论影像学检测结果佐证了滑车上动脉存在恒定皮支,以其分支为血管蒂设计的额部皮瓣提高了鼻再造疗效。

Imaging study on supratrochlear artery and its application in nasal reconstruction

Objective To study the image of the muscular and cutaneous branches of supratrochlear artery by internal and external carotid angiography and to design the frontal flap for nasal reconstruction.Methods The muscular and cutaneous branches of supratrochlear artery of 30 adults were investigated through internal and external carotid angiography and three-dimensional reconstruction of vessels to explore the courses of branches of supratrochlear artery and their communication with supraorbital artery.According to image observation,the frontal flap was designed and used to perform nasal reconstruction in 11 cases of nasal defects,including 7 males and 4 females with an average age of 23 years(range,15-48 years).The nasal defect ranged from 3.0 cm × 2.5 cm to 5.0 cm × 3.5 cm.Results Internal carotid angiography and three-dimensional imaging of the vessels showed that supratrochlear artery was found in 30 patients,with a diameter of(0.9 ± 0.6) mm.The superficial cutaneous branch appeared constantly with a diameter of(0.7 ± 0.3) mm.Deep muscular branch traveled among frontal muscle,with a diameter of(0.5 ± 0.5) mm and a length of(32.0 ± 6.2) mm,and it was missing in 4 patients,the branches communicated with each other and with supraorbital artery.All flaps survived with good appearance and without cartilage exposure.After 4 months to 3 years of follow-up,the postoperative aesthetic appearance and function of nasal tip,alar,and columella were satisfactory;the height and slope length of the external nose were moderate;and the reconstructed nose had good texture and normal ventilation function without constriction of naris.Conclusion Imaging studies support the fact that supratrochlear artery has constant cutaneous branch.The application of frontal flap pedicled with cutaneous branch can improve the effectiveness of nasal reconstruction.