成人旋髂深动脉穿支皮瓣嵌合髂骨瓣的应用解剖与临床分析.docx

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1、行修复的骨缺损合并皮肤软组织缺损的病例，并设其为对照组；设研究组为2008年3月至2011年6月期间，应用旋骼深动脉穿支皮瓣嵌合的骼骨瓣修复的20例骨缺损合并皮肤软组织缺损的病例。分别比较两组病例骨瓣的愈合时间、皮瓣坏死和臃肿的发生率，观察旋骼深动脉穿支皮瓣嵌合骼骨瓣的临床疗效。纟吉果对照组：术后皮瓣7例出现不同程度坏死：1例完全坏死，予另设计股前外侧皮瓣修复愈合；1例部分坏死，2例边缘坏死，3例表皮坏死，通过扩创或植皮后愈合。皮瓣中有7例外观较臃肿，4例稍臃肿。研究组：术后20例皮瓣全部存活，其中19例完全愈合，仅1例皮瓣边缘表皮部分皮肤坏死，换药

2、后愈合。3例皮瓣稍臃肿，外观较满意。供区均直接缝合，仅留线性疤痕。术后随访见两组骨瓣愈合时间无差异(P>0.05),研究组皮瓣坏死(5%)和臃肿发生率(15%)发生率较对照组(35%和55%)低，存在统计学意义(P<0.05)o纟吉论旋骼深动脉穿支皮瓣嵌合骼骨瓣具有临床可行性，骨瓣和皮瓣适度分离更有利于临床应用，可降低术后皮瓣坏死风险，同时减少了对供区损伤，皮瓣无明显臃肿，增加了皮瓣美观，是临床修复骨缺损并皮肤软组织的有效方法之一。关键词骨缺损；嵌合皮瓣；显微外科AbstractChapterIAppliedAnatomicStudyoftheadu

3、ltchimericosteocutaneousperforatorflapwithdeepiliaccircumflexarteryObjectiveToprovideanatomicevidencefortheapplicationofthedeepcircumflexiliacarteryperforatorflapbyapproachingthecourse,branches,number,area,lengthsandtheexternaldiametersofcutaneousbranchesbasedonthedeepcircumfle

4、xiliacarteryperforatorflap.MethodsChoose10freshChineseadultcadaverswereperfusedwithredlatexandperformedmicro-anatomytoobservethenumberofperforatorsbasedonthedeepcircumflexiliacarteryperforatorflapin20sides,andtheirbranchesdistribution,externaldiameters,thepediclelengths,thepedi

5、clewidths,andthedistributionareaoftheperforatingpointbasedonthedeepcircumflexiliacarteryperforatorflap.Onesideofthespecimenwassimulatedtheoperationofthechimericosteocutaneousperforatorflapwithdeepiliaccircumflexartery.ThedatawereanalyzedwithSPSS13.0statisticalsoftware.ResultsTh

6、edeepiliaccircumflexarterycouldbedividedintothreesegmentsaccodingtoitsroute:theinguinalone,theiliacspinaloneandthesuperioriliacspinalone.Thesuperioriliacspinalsegmentdevelopedintoamyocutaneousartery,perforatingthroughthedeepfasciatodominatetheskin.Totally22perforatorflapswerefo

7、undin20sideof10cadavers(onaverage1.1).Theexternaldiameterofthedeepiliaccircumflexvesselpediclewas(2.72±0.05)mm,andthepediclelengthwas(6.28±0.67)cm.Theexternaldiameteroftheperforatoratdeepfasciawas(0.72±0andthepediclelengthwas(3.79±0.38)cm.Theperforatorthroughthedeepfasciaareaap

8、pearattheintersectionof5.33cmabovetheanteriorsuperiori