经旋股内侧动脉深支和旋股外侧动脉升支介入治疗股骨头缺血性坏死的应用解剖

对 50例成人下肢标本的旋股内侧动脉深支和旋股外侧动脉升支的起源、起点、外径、走行、分布以及经这二支血管介入有关的结构进行观测 ,为介入治疗股骨头缺血性坏死提供更接近病变部位及可进行插管的血管。结果表明 ,旋股外侧动脉升支与横支共干起自旋股外侧动脉者占 68% ,升支单独起自旋股外侧动脉占 2 6 % ;旋股内侧动脉深支由旋股内侧动脉主干延续而来。旋股内、外侧动脉深支或升支起点外径分别为 3 0± 0 8mm、 2 8± 0 7mm。从股动脉的起点 ,经股深动脉、旋股外侧动脉至其升支长度为 7 1± 1 1cm ;经股深动脉、旋股内侧动脉至其深支长度为 5 6± 1 4cm。旋股内侧动脉与其深支间约呈 90 。 角 ;旋股外侧动脉与其升支间约呈 1 33。 角。旋股内、外侧动脉深支 (升支 )为营养股骨头和颈的血管 ,这二支血管符合导管插入要求     

介入治疗股骨头缺血性坏死的应用解剖

目的 介入治疗股骨头缺血性坏死提供解剖学基础.方法 选用经乳胶灌注防腐成人下肢标本20侧及新鲜成人下肢标本2侧,观察股深动脉的起点方位及分支类型,测量股深动脉及各分支长度和外径以及各分支起始部的角度.结果 股深动脉主要从股动脉后方(36.4％)和后外侧方(36.4％)发出,旋股内侧动脉从股深动脉发出(72.7％),从股动脉发出(27.3％).各主要血管的长度为:股深动脉(19.22±10.19) mm,其根部距腹股沟韧带的距离为(38±11.78)mm;旋股内侧动脉(12.56±6.17) mm;旋股外侧动脉(13.93±11.04) mm.各主要血管的外径为:股深动脉(5.20±1.57)mm,旋股内侧动脉(3.64±0.99) mm,其升支(2.66±0.99)mm;旋股外侧动脉(4.48±1.19) mm,其升支(2.12±0.59) mm.旋股内侧动脉升支以与主干成接近90°的夹角;旋股外侧动脉与其升支间约呈115.82°夹角.结论 熟悉股动脉应用解剖,有利于完善这种治疗方法.     

吻合血管腓骨修复股骨颈骨折与股骨头坏死的解剖学

目的：对吻合血管腓骨移植修复股骨颈骨折与股骨头缺血性坏死进行解剖学再探讨。方法：成人下肢标本,观测供区、受区血管的解剖学。结果：(1)观测了腓动脉及其伴行静脉起点的位置和外径及腓骨滋养动脉的分布。(2)观测了旋股外侧动脉及其升支的起点位置、干长和外径及其伴行静脉的外径。结论：旋股外侧血管升支为术式首选的受区血管,将腓动脉与旋股外侧血管的升支吻合,有利于重建股骨头颈的血供。     

以股后皮神经及其营养血管为蒂皮瓣的应用解剖

目的：为膝后区带股后皮神经及其营养血管筋膜皮瓣提供解剖学基础。方法：在３２侧成人下肢标本上，对膝后区的股后皮神经及其营养血管进行详细观测。结果：股后皮神经在窝上角处的横径为１．７±０．６ｍｍ，在该区的干长为１６．１±２．３ｃｍ。营养动脉平均２．３（１～３）条，外径为０．８±０．３ｍｍ，分别来源于穿动脉的肌皮支（占４９．３％）和动脉的筋膜皮支（占５０．７％）。静脉回流有营养动脉的伴行静脉和浅静脉，外径分别为１．１±０．５ｍｍ和２．１±１．９ｍｍ。结论：该区的神经血管恒定，可制成带感觉的转位筋膜皮瓣，用以修复膝关节附近的软组织缺损。     

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。     

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。     

股深动脉及其分支的应用解剖学观察

在50侧成人尸体上观察股深动脉类型,测量其长度和外径.股深动脉主要从股动脉后方(60%)和后外侧(2 6%)发出;可分为4种主要类型深全干型(60%)、深外干型(20%)、深内干型(14%)和深孤独干型(6%).各主要血管长度和外径分别为股深动脉18.0±8 .7mm,5.7±1.6mm;旋股内侧动脉17.6mm±10.7mm,3.6±1 .0mm;旋股外侧动脉14.8±9.6mm,3.7±1.1mm.研究数据为显微外科学和介入放射学提供解剖学依据.     

腓肠内外侧血管解剖特点及其在小腿创伤修复中的意义

目的：为小腿创伤皮瓣移植修复与腓肠内、外侧血管吻合提供解剖学基础。方法：在７０侧成人下肢标本上解剖观测了腓肠内、外侧血管的长度、外径、血管神经的毗邻关系及其形态特点。结果：①腓肠内、外侧动脉起于动脉，伴行静脉注入静脉；②动脉起点至入肌段的长度内、外侧分别为４．１±０．７（１．８～６．４）ｃｍ、３．７±０．５（２．０～６．５）ｃｍ；③肌门处内、外侧动脉的外径分别为２．２±０．１（１．１～３．４）ｍｍ、２．０±０．１（０．９～３．１）ｍｍ；④肌门处伴行静脉有１～２条，内、外侧静脉外径为２．５±０．３（１．８～４．５）ｍｍ，２．３±０．３（１．５～４．１）ｍｍ。结论：腓肠内、外侧血管恒定、径粗、较长，是小腿创伤皮瓣移植修复受区可供应用的吻合血管     

第1穿动脉升支大转子骨瓣在股骨颈（距）重建中的应用

目的：报道应用第１穿血管升支大转子骨瓣转位重建股骨颈（距）手术方法。方法：在４０侧成人下肢标本上，解剖观察了第１穿动脉的分支分布情况。结果：股深动脉于小转子尖下方４．５±１．７ｃｍ处发出第１穿动脉，外径为２．８±０．７ｍｍ，第１穿动脉分为升支和降支，升支走向大转子方向，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。自１９９１年始，以第１穿动脉为蒂切取大转子骨瓣转位修复股骨颈和股骨距缺损８例，疗效满意。结论：以第１穿血管为蒂的大转子骨瓣，可用于股骨颈及股骨距缺损的修复与重建     

股骨中段骨膜瓣移植的解剖及其临床应用

在４５侧经动脉内灌注红色乳胶的成人下肢标本上，解剖观测了股中间肌近端血管及其骨膜支的来源，分支分布。结果表明：近端的股动脉来自旋股外侧动脉占５７．５％；来自股深动脉占２８．９％；来自股动脉占１３．１％。肌动脉干长１５．８±０．７ｍｍ，外径２．２±０．７ｍｍ。８８．９％的骨膜支来自肌动脉，经股中间肌与股内侧肌之间的间隙，达股骨中段前份。骨膜支干长３６±１１ｍｍ，外径１．５±０．４ｍｍ。以肌动脉为蒂，     

Distinct intergender difference in the femoral artery ramification patterns found in the Turkish population: angiographic study

Using 600 bilateral femoral angiographies (300 male lower extremities and 300 female lower extremities), we observed configurations of the femoral origins of the medial circumflex femoral artery (MCFA), lateral circumflex femoral artery (LCFA) and the deep femoral artery. The distinct intergender difference was found in the incidence of direct origin of the MCFA from the femoral artery (17.8% and 80.0% in male and female limbs, repsectively). The LCFA also exhibited a marked difference between genders in the incidence of direct origin. The Turkish population seemed to be characterized by an intergender difference in specific somatic arterial morphology.     

Patterns of the circumflex femoral arteries revisited

Knowledge of variations of the circumflex femoral arteries is important when undertaking clinical procedures within the femoral region and in hip joint replacement. Since the 19th century, many different patterns have been proposed to classify their origins. This work studied a statistically reliable sample, the lower limbs of 221 embalmed human cadavers (equal right-left and approximately equal sex distributions), and reviewed the previous literature to propose a unified and simple classification that will be useful to clinicians. Statistical comparisons were made using the chi(2) test. The medial and lateral circumflex femoral arteries have been classified into three different patterns based on the levels of their origin. Distribution related to sex and side was also studied. Pattern I: Both arteries arose from the deep femoral artery (346 cases, 78.8%). This pattern was more frequent in females, P = 0.01. There was no significant difference between sides. Type Ia, medial circumflex femoral artery origin was proximal to the lateral circumflex femoral artery origin (53.2%); Type Ib, lateral circumflex femoral artery origin was proximal to medial circumflex femoral artery origin (23.4%); Type Ic, both arteries arose from a common trunk (23.4%). Pattern II: One of the arteries arose from the femoral artery and the other from the deep femoral artery (90 cases, 20.5%). Type IIa, the medial circumflex femoral artery arose from the femoral artery (77.8%) and Type IIb, the lateral circumflex femoral artery arose from the femoral artery (22.2%). There were no significant differences between sexes or sides. Pattern III: Both arteries arose from the femoral artery (2 cases, 0.5%). In every disposition there was a significantly higher prevalence of unilateral rather than bilateral occurrence. In one dissection the medial circumflex femoral artery was absent. Awareness of these variations could avoid unexpected injuries.     

股骨头颈骨外营养血管的应用解剖学研究

本文采用显微解剖剥离方法对25例(50侧)胎儿股骨头颈骨外营养血管的分布、变异及应用解剖学进行了研究。以期为临床应用提供更加详细的解剖学资料。     

Deep and superficial circumflex iliac arteries and their relationship to the ultrasound‐guided femoral nerve block procedure: A cadaver study

The in‐plane lateral to medial approach is a standard technique for ultrasound‐guided femoral nerve block (USG‐FNB). The first bifurcation of the femoral artery, which consists of the deep artery of the thigh (DAT) or occasionally the lateral circumflex femoral artery (LCFA), is regarded as the distal border for this procedure. We sometimes detect arteries along the estimated needle trajectory for USG‐FNB. The superficial (SCIA) and deep (DCIA) circumflex iliac arteries run laterally parallel to the inguinal ligament from the femoral or external iliac artery. The relationship between the SCIA and DCIA and other anatomical structures related to USG‐FNB around the femoral triangle region was studied by gross anatomical examination of 100 formalin‐fixed adult cadavers. At least one SCIA and one DCIA were identified around each femoral triangle; 81.8% of SCIA and 58% of DCIA originated from the femoral artery. All DCIA coursed between the fascia lata and fascia iliaca and 80% of SCIA penetrated the fascia lata. In 94% of femoral triangles, at least one arterial branch heading towards the lateral part of the thigh originated from the femoral artery from the level of the inguinal ligament to the first bifurcation of the femoral artery. The presence of SCIA and DCIA should be considered during USG‐FNB using the in‐plane lateral to medial approach to avoid inadvertently injuring them, as they are occasionally located along the presumed needle trajectory superficial to the fascia iliaca. Clin. Anat. 30:413–420, 2017. © 2017 Wiley Periodicals, Inc.     

旋股外侧动脉降支骨膜支为蒂的股骨中上段骨膜瓣的应用解剖

目的 :提供以旋股外侧动脉降支骨膜支骨膜瓣转位治疗股骨颈骨折、股骨头缺血性坏死和股骨干中下段骨不连的解剖学基础。方法 :在 3 2侧灌注红色乳胶的成人标本上 ,对旋股外侧动脉降支骨膜支的起始走行、分支分布进行解剖学观测 ;2侧新鲜标本注入墨汁观察骨膜支的供血范围。结果 :88%的降支发自旋股外侧动脉 ,其骨膜支于降支起始 4.0± 1.1cm处发出 ,外径 1.2± 0 .5mm ,长 7.1± 1.8cm ,经股内侧肌与股中间肌之间或穿股中间肌 ,分布于股骨中上段前内侧骨膜。结论 :以旋股外侧动脉降支骨膜支为蒂的骨膜瓣 ,可顺行修复股骨头颈骨折 ,逆行修复股骨中下段骨不连、股骨头缺血性坏死。     

旋股外侧动脉降支用于冠状动脉旁路术的可行性研究

目的 为旋股外侧动脉降支用于冠状动脉旁路术提供解剖学依据,并对其手术切取方法进行初步设计。方法 对19具福尔马林保存成年尸体38侧旋股外侧动脉起始部及其降支的走行、分支及周围结构进行详细的观察,测定旋股外侧动脉降支主干的长度、起点和止点处的外径,以及髂前上棘至髌骨中点连线的中点到股外侧肌与股直肌间沟的水平距离。结果 旋股外侧动脉降支位置较为恒定,位于股中间肌、股直肌、股外侧肌之间的肌间隙内。主干长度为12.0±2.36cm,起点处外径为2.7±0.35mm,止点处外径为2.2±0.28mm,髂前上棘至髌骨中点连线的中点到股外侧肌、股直肌间隙前外侧缘的水平距离为0.4±0.18cm。结论 旋股外侧动脉降支的解剖特点符合冠状动脉旁路术的要求,可以用于该手术,经股直肌和股外侧肌间隙可方便切取该动脉。     

带旋股外动脉升支髂骨瓣加空心加压钉治疗股骨颈骨折

目的：报道旋股外侧动脉升支髂骨瓣加空心加压螺钉治疗青壮年股骨颈骨折的手术方法及临床效果。方法：在解剖学研究的基础上，设计并应用旋股外侧动脉升支髂骨瓣加空心加压螺钉治疗青壮年股骨颈骨折36例。结果：36例中，优22例，良11例，可2例，差1例。33例骨折完全愈合，3例出现股骨头坏死，优良率91．7％。结论：该术式骨瓣血供丰富，固定牢靠，操作简便，创伤小，是治疗青壮年股骨颈骨折的一种有效方法。