以第1或第2穿动脉为蒂骨瓣转位重建股骨距的应用解剖

目的：为带血管蒂骨瓣转位重建股骨距提供解剖学依据。方法：３０侧经动脉内灌注红色乳胶的成人下肢标本，对第１、２穿动脉起始、走行、分支分布和骨膜支进行详细的解剖学观察。结果：股深动脉在小转子尖下４．５±１．３ｃｍ、９．３±２．７ｃｍ处分别发出第１、２穿动脉，外径分别为２．８±０．７ｍｍ、２．４±０．６ｍｍ。穿动脉发出１～３支外径在１．０ｍｍ以上的肌骨膜支，分布于股骨后部中上段骨膜。结论：可以第１或第２穿动脉为蒂设计股骨瓣，可转位重建股骨距或修复股骨颈。     

第一穿动脉血管蒂骨瓣在股骨上段骨缺损修复中的临床应用

目的:为应用第一穿动脉血管蒂骨瓣转位修复股骨上段骨缺损提供解剖学依据及手术方法。方法:在40侧成人下肢标本上,解剖观察了第一穿动脉的分支分布及吻合特点。结果:发现股深动脉于小转子尖下方4.5±1.3cm处发出第一穿动脉,外径为2.8±0.7mm。第一穿动脉分为升支和降支,升支走向大转于方向,发出外径1.0mm以上的肌骨膜支,分布于臀大肌下部和大转子等处,并参与十字吻合;降支粗长,参与股骨后部血管链的形成。自1991年始,以第一穿动脉为蒂切取骨瓣转位修复股骨上段骨缺损12例,疗效满意。结论:第一穿动脉为蒂的骨瓣,用于股骨颈、股骨距和股骨上段骨缺损的修复,疗效可靠。     

旋股外侧血管横支大转子骨瓣修复股骨中上段的解剖及应用

目的：为股骨干骨缺损、骨折骨不连修复提供新的手术方法，方法：在４０侧标本上对旋股外侧动脉横支进行解剖学观察，设计了以该血管为蒂大转子骨瓣转位修复股骨干中、上段及股骨头颈部骨折、骨缺损。结果：该动脉外径２．５ｍｍ，长度５．１ｃｍ，在股外侧肌深面和外缘发出２～４支外径在０．４～１．１ｍｍ的骨膜支到大转子前外侧，供应范围３．５ｃｍ×２．０ｃｍ×３．５ｃｍ。结论：以旋股外侧动脉横支为蒂大转子骨瓣移位修复股骨中段或上段骨缺损具有可行性，临床应用１５例，疗效满意。     

大转子区筋膜骨膜血管分布及其临床意义

目的：为股方肌蒂大转子筋膜骨膜骨瓣移位术提供解剖学基础。方法：在３４侧下肢标本上对大转子区筋膜和骨膜的形态特点及其血供进行了解剖学观察。结果：大转子区筋膜较厚,分浅、深两层,与臀大肌筋膜和大转子骨膜通过疏松结缔组织相连。筋膜和骨膜的动脉来源为多源性,来自旋股内侧动脉深支、臀下动脉大转子支、第１穿动脉升支、旋股外侧动脉升支和横支。它们在大转子形成广泛的吻合。旋股内侧动脉深支管径为１．７±０．５ｍｍ,长３．３±０．７ｃｍ,其筋膜支和骨膜支是大转子的主要营养血管。臀下动脉大转子支管径１．４±０．５ｍｍ,长５．２±０．８ｃｍ,常与旋股内侧动脉深支吻合。结论：带筋膜血管的骨膜骨瓣比不带筋膜的骨膜骨瓣血供丰富。根据大转子区筋膜和骨膜的血管分布特点,可设计带筋膜血管的股方肌蒂大转子骨膜骨瓣。     

以颈横动脉浅支为蒂肩胛冈骨瓣枕颈融合术的应用解剖

目的：为枕颈融合术提供带血管蒂骨瓣转位术的应用解剖学基础。方法：在３０侧经动脉灌注红色乳胶的成人尸体标本上，解剖观测颈横动脉浅支的走行、分支及分布；另在１侧标本上摹拟手术设计。结果：颈横动脉浅支主要分支有肩胛冈支和斜方肌支。肩胛冈支外径１．６±０．３ｍｍ，长度４．９±０．６ｃｍ；斜方肌支可分为升支和降支，其中升支水平横向正中线，在第７颈椎棘突附近与颈深动脉后支及邻近皮支相吻合，斜方肌支—升支长达６．７ｃｍ，起始外径１．５±０．３ｍｍ。结论：在颈横动脉肩胛冈支和斜方肌支分支前结扎动脉干，可以斜方肌支—肩胛冈支为蒂设计肩胛冈骨瓣转位行枕颈融合的术式。     

腓血管蒂比目鱼肌皮瓣逆行转位修复术的应用解剖

目的：为以腓血管为蒂比目鱼肌皮瓣逆行转位修复小腿中、下段组织缺损提供解剖学基础。方法：在３３侧经动脉灌注乳胶的下肢标本及６侧动脉铸型下肢标本上,解剖观测比目鱼肌形态,腓动脉比目鱼肌支的分布及腓动脉与胫前、后动脉之间的吻合。结果：腓动脉发出１～４条比目鱼肌支,外径２．０±０．５（１．０～３．８）ｍｍ,由其发出至皮肤的血管在比目鱼肌内或沿肌间隔穿行,穿出点在腓骨头下９．９±３．０ｃｍ,分布范围１６ｃｍ×９ｃｍ。腓动脉下端与胫前、后动脉间有丰富的吻合支和粗大的交通支,最近端交通支距内、外踝连线５．５±０．８（３．６～７．４）ｃｍ,外径１．２±０．３ｍｍ。结论：以腓血管为蒂可以形成比目鱼肌皮瓣;该瓣逆行转位可修复小腿中下段缺损,具有血供可靠、损伤小、操作简单的优点     

带血管蒂下颌骨瓣转位上颈椎融合术的应用解剖

目的：为上颈椎植骨融合术提供带血供骨瓣转位的应用解剖基础。方法：在３０侧成人头颈标本上，对颏下动脉的走行、分支及分布进行观测，并在标本上进行摹拟术式设计；②测量３０块成年干燥下颌骨有关数据。结果：①颊下动脉恒定由面动脉在下颌骨下级附近发出，起始外径为１．８±０．４ｍｍ、长度２．５±０．５ｃｍ，沿下颌骨下缘前行，在正中线处与对侧同名动脉吻合，沿途发出皮支、肌支、腺支及骨膜支等。其中下颌骨膜支２～５支，外径０．３±０．１ｍｍ，供骨面积为２．６ｃｍ×５．４ｃｍ。结论：可以面动脉为蒂带颏下动脉设计下颌骨瓣转位行上颈椎植骨融合的术式。     

股骨前面血供分布特点与骨膜（骨）瓣设计

目的：为股骨干骨折骨不连、骨缺损设计骨膜（骨）瓣修复术式提供解剖学基础。方法：在４０侧成人下肢标本上，对股骨前面骨膜血管的来源、走行、分支、分布及其吻合进行观测，并在标本上进行摹拟术式设计。结果：股骨前面骨膜血供，来自股外侧肌支、股中间肌支、膝降动脉、膝上外动脉、股动脉和股深动脉肌间隔支呈节段性分布的肌骨膜支和骨膜支。肌骨膜支外径１．４～１．７ｍｍ，长度１．７～５．６ｃｍ；骨膜支外径０．４～０．６ｍｍ，长度１．２～１．５ｃｍ。骨膜血管多呈向下或水平走行，达骨膜后分出升支、降支及吻合支，相互吻合成网。结论：可以节段骨膜支为蒂设计股骨前面骨膜瓣，修复股骨干骨折骨不连、骨缺损     

带血供肱骨下段内侧骨（膜）瓣移位术的应用解剖

目的：为带血供肱骨下段骨瓣移位术提供解剖学基础。方法：４０侧成人上肢标本，观测尺侧下副动脉、尺侧返动脉的起始、走行、分支分布、骨膜支和吻合。结果：尺侧下副动脉距髁间连线上３．７±１．７ｃｍ始于肱动脉，外径１．８±０．４ｍｍ，长１．８±０．７ｃｍ，骨膜支１～３支，外径０．８±０．４ｍｍ分布肱骨下段内侧半骨膜。尺侧返动脉前干外径１．１±０．２ｍｍ。尺侧上副动脉、尺侧下副动脉、尺侧返动脉在肱骨内上髁附近互相吻合。结论：利用上述血管吻合关系，设计带血供的肱骨（膜）瓣或骨皮瓣，可移位修复肱骨中上段、尺、桡骨中段骨折骨不连。临床应用已取得良好效果。     

斜方肌下部肌瓣转位重建屈肘屈指功能的应用解剖

目的：为斜方肌下部肌瓣转位重建屈肘屈指功能提供解剖学基础。方法：在３４侧经动脉内灌注红色乳胶的成人标本上，解剖观测斜方肌下部的形态、血供及神经支配。结果：①斜方肌下部肌质部分长２４．７±２．７ｃｍ、宽９．８±１．３ｃｍ、厚０．４±０．１ｃｍ。其远端移行为腱膜，长２．８±０．８ｃｍ、宽１．５±０．４ｃｍ、厚０．０３±０．０１ｃｍ；②肩胛背动脉内侧终末支的后支营养斜方肌下部，外径１．２±０．３ｍｍ，长度１．７±０．８ｃｍ；③斜方肌下部受副神经支配。结论：在斜方肌具有Ⅳ级肌力的前提下，可以副神经肩胛背动脉内侧终末支的后支为蒂设计斜方肌下部肌瓣转位重建屈肘屈指功能的术式     

Variation in the Origin of Cystic Artery

In recent years, an extensive development in laproscopic surgery has made surgeons to obtain a clear appreciation and knowledge of variations in the blood supply of gall bladder. The study was done on specimens including 35 embalmed cadavers and 15 fresh postmortem specimens by dissection method at JSS Medical College. In the present study we observed that the cystic artery from right hepatic was seen only in 54% cases. Whereas from hepatic artery proper in 22%, from common hepatic in 12%, from gastroduodenal in 8%, and from superior mesenteric in 2% of cases. Cystic artery from superior mesenteric passes through head of pancreas. This variation is very important for surgeons during resection of pancreas. Because of very limited field of vision during laproscopic surgery, haemorrhage could be a problem if these variations are overlooked. Sound knowledge of cystic artery variations is helpful for surgeons while performing upper abdominal surgeries.     

Variability in the Origin of the Obturator Artery

INTRODUCTION

General surgeons dealing with laparoscopic herniorrhaphy should be aware of the aberrant obturator artery that crosses the superior pubic ramus and is susceptible to injuries during dissection of the Bogros space and mesh stapling onto Cooper’s ligament. The obturator artery is usually described as a branch of the anterior division of the internal iliac artery, although variations have been reported.

MATERIALS AND METHODS

The present study was conducted on 98 pelvic halves of embalmed cadavers, and the origin and course of the obturator artery were traced and noted.

RESULTS

In 79% of the specimens, the obturator artery was a branch of the internal iliac artery. It branched off at different levels either from the anterior division or posterior division, individually or with other named branches. In 19% of the cases, the obturator artery branched off from the external iliac artery as a separate branch or with the inferior epigastric artery. However, in the remaining 2% of the specimens, both the internal and the external iliac arteries branched to form an anastomotic structure within the pelvic cavity.

CONCLUSION

The data obtained in this study show that it is more common to find an abnormal obturator artery than was reported previously, and this observation has implications for pelvic surgeons and is of academic interest to anatomists. Surgeons dealing with direct, indirect, femoral, or obturator hernias need to be aware of these variations and their close proximity to the femoral ring.     

Consideration of the potential courses of the common iliac artery

We encountered a rare case of the left common iliac artery in a 92-year-old Japanese female cadaver during dissection practice for medical students. The artery entered into the small pelvis without branching to the external iliac artery. There, it went down slightly medially and then turned laterally and passed behind the first sacral nerve. The artery ran anterolaterally further and returned to the greater pelvis and became the external iliac artery, which continued to the femoral artery as usual. During the course in the small pelvis, the artery branched to give rise to each branch of the internal iliac artery. We speculate that in the present case, a communication between the median sacral artery and the superior gluteal artery, passing behind the first sacral nerve, enlarged and compensated the usual common iliac artery.     

Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature

A total of 192 embalmed cadavers were examined in order to present a detailed study of arterial variations in the upper limb and a meta-analysis of them. The variable terminology previously used was unified into a homogenous and complete classification, with 12 categories covering all the previously reported variant patterns of the arm and forearm.     

An unusual variation of the superficial ulnar artery

Anomalous superficial ulnar arteries were found bilaterally during routine dissection of the upper limbs of a 60-year-old male cadaver. In the left arm, the superficial ulnar artery originated from the axillary artery. It crossed the median nerve anteriorly and ran anteromedial to this nerve and the brachial artery. The superficial ulnar artery was also rudimentary and gave rise to only a narrow muscular branch to the biceps brachii. In the hand, it anastomosed with the radial artery, completing the superficial palmar arch. The radial artery was larger than usual and the deep palmar arch was formed only by the radial artery. In the right arm, the superficial ulnar artery originated from the brachial artery at the level of the inter-epicondylar line. Additionally there were “inverse palmaris longus muscles” bilaterally. This was a rare case in which the superficially ulnar artery originated from a different source on each side accompanied by anomalies of the palmar arches on one side.     

肩胛下血管蒂复合组织瓣移植的解剖学基础

目的：为以肩胛下血管为蒂复合组织瓣移植提供解剖学基础。方法：４０侧成人上肢标本解剖观察肩胛下动脉的分支类型及分布。结果：肩胛下动脉分支有３种类型：①肩胛下动脉直接分出旋肩胛动脉和胸背动脉,占５２．５％;②肩胛下动脉发出旋肩胛、胸背、旋肱后或胸外动脉,占４０％;③旋肩胛动脉与胸背动脉分别起于腋动脉,占７．５％。旋肩胛动脉恒定发浅、深支,浅支分布于肩胛冈下部筋膜皮肤,深支分布于肩胛骨外侧缘。胸背动脉恒定发肩胛骨支、前锯肌支,分布于肩胛骨外侧缘中下部、前锯肌及第５～７肋。胸背动脉于肩胛骨下角上方１．９ｃｍ处分为内、外侧支。结论：９２．５％可以肩胛下血管为蒂形成：①肩胛（骨）皮瓣与背阔肌皮瓣;②肩胛（骨）皮瓣与侧胸皮瓣;③肩胛（骨）皮瓣与前锯肌肋骨瓣。７．５％则可以胸背动脉为蒂形成背阔肌皮瓣与前锯肌肋骨瓣。     

Multiple variations in the paired arteries of the abdominal aorta

Variations in the origin of arteries in the abdomen are very common. The arteries that show frequent variations include the celiac trunk, renal arteries, and gonadal arteries. We observed multiple variations in a 45-year-old male cadaver. The variations found on the left side were: one accessory renal artery, two testicular arteries, and middle suprarenal and inferior phrenic arteries that branched from the celiac trunk. On the right side, the inferior phrenic and middle suprarenal arteries arose from the right renal artery.     

Anomalous meningeal branches of the ophthalmic artery feeding meningiomas of the brain convexity

Summary Many anomalies may involve the ophthalmic and middle meningeal arteries, because of the close relationship of their development. The system of the ophthalmic artery may supply the dural convexity by the middle meningeal artery of ophthalmic origin, the anterior branch of the middle meningeal artery or an accessory meningeal artery. The development and the anatomic arrangement of these anomalous vessels are discussed. Three cases of meningiomas of the brain convexity supplied by anomalous meningeal arteries arising from the ophthalmic artery are described. In one case internal carotid angiography showed an anomalous anterior branch of the middle meningeal artery arising from the ophthalmic artery, whereas the maxillary artery provided only the posterior branch of the middle meningeal artery. In two cases the middle meningeal artery system was normal, but the ophthalmic artery provided an accessory meningeal artery supplying the meningioma. Whereas an ophthalmic origin of the middle meningeal artery is rather common, the angiographic finding of an accessory meningeal artery or an anterior branch of the middle meningeal artery arising from the ophthalmic arterial system is exceptional. The preoperative embolization of dural lesions supplied by anomalous meningeal vessels of ophthalmic origin is dangerous because of the risk of embolization into the ophthalmic circle.

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Branches méningées anormales de l'artère ophtalmique alimentant les méningiomes de la convexité

Résumé Un grand nombre d'anomalies touche les aa. ophtalmique et méningée moyenne en raison de leurs liens embryologiques. Le système de l'a. ophtalmique peut vasculariser la dure-mère de la convexité lorsqu'elle donne naissance à l'a. méningée moyenne ou à sa branche antérieure, ou à l'a. méningée accessoire. Le développement et la disposition anatomique de ces anomalies vasculaires sont discutés. Trois cas de méningiomes de la convexité, alimentés par des aa. méningées provenant de l'a. ophtalmique, sont décrits. Dans un cas, l'opacification de l'a. carotide interne montrait que la branche antérieure de l'a. méningée moyenne provenait de l'a. ophtalmique ; l'a. maxillaire ne donnait alors que sa branche postérieure et l'a. méningée moyenne. Dans deux cas, le système de l'a. méningée moyenne était normal, mais l'a. ophtalmique donnait une a. méningée accessoire vascularisant le méningiome. Alors que l'origine ophtalmique de l'a. méningée moyenne est relativement commune, la naissance à partir de l'a. ophtalmique de l'a. méningée accessoire ou de la branche antérieure de l'a. méningée moyenne est exceptionnellement décrite en angiographie. L'embolisation pré-opératoire des lésions durales alimentées par les vaisseaux méningés anormaux provenant de l'a. ophtalmique est dangereuse en raison des risques oculaires.

     

Branching patterns of the popliteal artery and its clinical importance

Purpose  The aim of this study was to evaluate the popliteal artery branching patterns and related measurements. Methods  A cadaveric study in forty lower limbs was performed to improve the understanding of anatomy of the popliteal artery and its main branches. Results  Normal branching of the popliteal artery was present in 36 specimens (90%). High origin of the anterior tibial artery was seen in two specimens (5%). The bifurcation was at the level of proximal border of popliteus, but the posterior tibial artery originated directly from the popliteal artery in one specimen (2.5%). Trifurcation pattern with no trunk was observed in one specimen (2.5%). Conclusions  We believe that a review of the anatomic characteristics of the popliteal artery and its branches will be beneficial for the surgical approaches and the choice of suitable arterial graft sites. This study was presented at 9th Congress of European Association of Clinical Anatomy in Prague, 5–8 September 2007.     

Anatomy of the arterial vascularization of the lips

Summary The findings from 12 dissections of previously injected facial masks, 8 dissections of the face following intrarterial injection of a red solution of Latex Neoprene, and a corrosion cast specimen allowed us to study the arterial supply of the lips. The arterial supply of the upper lip arises mainly from the superior labial arteries, but also from the subseptal arteries and from the subalar arteries. There is a figure of 8 shaped anastomotic system between these arteries lying on the upper lip. The arterial supply of the lower lip arises from the inferior labial arteries and from branches of the mental artery. A constant inferior labial arterial network was shown at the level of the lower lip arising in a fifth of cases from a T-shaped inferior labial artery. All these recent anatomic findings help us to improve our understanding of plastic surgery of the lips.

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Vascularisation artérielle des lèvres

Résumé Douze dissections de masques faciaux préalablement injectés à la gélatine minium, huit dissections de face après injection artérielle par une solution de latex néoprène rouge, et une injectioncorrosion a permis l'étude de la vascularisation artérielle labiale. La lèvre supérieure reçoit sa vascularisation artérielle des artères labiales supérieures principalement, mais aussi des artères sous-narinaires branches des artères faciales, et des artères de la sous-cloison. Il existe un système d'anastomose fréquent entre les trois artères décrivant un aspect de 8 de chiffre couché au niveau de la lèvre supérieure. La lèvre inférieure est vascularisée par les artères labiales inférieures et par des branches de l'artère mentonnière ; il existe de manière constante au niveau de la lèvre inférieure une arche artérielle labiale inférieure provenant une fois sur cinq d'une artère labiales inférieure en T unique. Toute ces données anatomiques récentes permettent d'envisager dans de meilleures conditions la chirurgie réparatrice des lèvres.