【作者】 刘俊；

【导师】 唐举玉；

【作者基本信息】 南华大学 ， 外科学， 2006， 硕士

【摘要】 目的：利用彩色多普勒超声成像技术，获取健康成人手、足部分血管(与拇指再造有关)的正常影像资料和变异率；了解患者供、受区血管的走行、内径大小和有无变异或病变，为足趾移植拇指再造提供合适的手术方案，从而缩短手术时间，减少供、受区创伤，提高足趾移植再造拇指的成功率。 方法：彩色多普勒超声检测分健康成人组和足趾移植拇指再造研究组。健康组选择40例健康成年学生的双侧手足，采用彩色多普勒超声检测足背动脉、第一跖背动脉及其趾蹼分支、大隐静脉、足背静脉、桡动脉及头静脉，获得正常人手、足部分血管(与再造术有关)的彩色多普勒影像数据。研究组选择36例拇指缺损拟用第二足趾移植再造病人，术前采用彩色多普勒超声检测对侧供区动脉血管情况，对侧动脉高危型(GilbertⅢ型、F型)患者同时检测同侧足的血管情况。对侧非高危型患者，切取对侧第二足趾移植再造拇指；对侧高危型则切取同侧第二足趾；如双侧均为高危型，仍然选择对侧第二足趾，同时保留两套供血系统，处理GilbertⅢ型时，不解剖足底深支，采用血管移植桥接足背动脉与趾动脉或吻合第二跖背动脉。同时检测供区静脉及受区动、静脉是否损伤或变异，明确后做相应的处理。并与既往传统手术组30例(术前未采用彩色多普勒超声检测)比较：包括足趾切取手术时间、术后供足行走痛发生率和再造成功率。 结果：健康组40例80只足：足背动脉缺如2足，占2.5％；按第一跖背动脉Gilbert分型：Ⅰ型42足，占52.5％，Ⅱ型28足，占35％，Ⅲ型10足，占12.5％；按趾蹼处分型：R型66足，占82.5％，T型4足，占5％，F型10足，占12.5％；大隐静脉缺如3足，占3.75％。80只手显示桡动脉、头静脉无缺如。研究组36例：对侧供区足背动脉无缺如，第一跖背动脉出现9例高危型，其中2例出现第二跖背动脉，6例同侧非高危型，1例双侧高危型。供区1例大隐静脉缺如。受区1例桡动脉—头静脉瘘，1例头静脉闭锁。再造36例拇指顺利成活，无1例发生血管危象。与传统手术组比较，研究组GilbertⅢ型足趾切取时间明显缩短，术后血管危象发生率降低，术后供足行走痛并发症减少。 结论： 1．彩色多普勒超声成像技术可以获得手、足部分血管(与拇指再造术有关)的正常影像资料和变异率。 2．彩色多普勒超声成像技术应用于足趾移植再造拇指术前检查，有利于优化更多还原

【Abstract】 Objective: To get the normal image data and the rate of the variation about the health adult’s part of blood vessels of the hands and feet(relevant to toe-to-thumb reconstruction), and to know if there was any damage or absence in the vascular systems of either the donor or the recipient site, and to know the condition of the courser, the size of caliber of the vessels with Color Doppler image formation technology, so as to provide suitable operation scheme before the toe-to-thumb reconstruction, shorten operation time, decrease wounds in either the donor or the recipient site and raise reconstruction survival rate.Methods: The subjects were divided into healthy adult group and the researchgroup for toe-to-thumb and underwent the Color Doppler checks .The healthy group consisted of 40 healthy adult students, with both their hands and feet checked by Color Doppler. The checks were performed for the donor site’s conditions of the dorsalis pedis artery, the first dorsal metatarsal artery and the branch of toe web, the great saphenous vein and the dorsum pedis vein, and recipient site’s condition of radial artery and cephalic vein’s courser, the size of caliber, to obtain part of the healthy adult’s blood vessel (relevant to reconstruction) image data of both of hands and feet by means of Color Doppler. In the research group, 36 patients were selected with single thumb coloboma intend to toe-to-thumb reconstruction. Before the operation, colour Doppler was used to examine the conditions of the opposite side of donor site’s artery, as for the patients with high risks(Gilbert IIImodel and F model in toe web) in the opposite side foot, the vessels of the same side foot were also examined. For those patients free from high risk in the opposite side foot, the second opposite side toe was to be transplanted, if the opposite side foot was of high risk mode, the same side toe was to be transplanted. If both feet were of high risk mode, the second opposite side toe was to be transplanted, two sets of blood-supply systems更多还原