功能性腘动脉陷迫综合征的CTA解剖特点初探

目的运用CTA标线法探讨功能性腘动脉陷迫综合征(functional popliteal artery entrapment syndromef,PAES)是否存在"解剖畸形"。方法 2007～2011年手术确诊的14条fPAES患肢与180条对照肢体的CTA进行比较,并用CTA标线法分析腘窝轴位上两组的解剖位置差异。结果 fPAES组所有患肢腓肠肌内侧头向外移位且13条(93%)向外超过了腘动脉,所有腘动脉均向深方移位;对照组腓肠肌内侧头完全起自"股骨内侧髁后上方"(解剖学所描述的标准位置)的仅占12%(21/180);对照组21%(38/180)腓肠肌内侧头与腘动脉相对位置关系及38%(68/180)的腘动脉深浅位置关系不符合标准解剖。结论腓肠肌内侧头的外移普遍存在,解剖"移位"可能从量变到质变f,PAES可能是严重移位导致的结果。内侧头外移超越腘动脉及腘动脉向深方移位是fPAES两个有意义的观察指标。

Preliminary CTA Study on the Anatomical Features of Functional Popliteal Artery Entrapment Syndrome

Objective To investigate whether "abnormal anatomy" exists in functional popliteal artery entrapment syndrome(fPAES) by CTA.Methods We compared the CTA results of 14 limbs with fPAES,which were diagnosed during 2006 to 2011,with 180 healthy limbs.The popliteal fossa anatomy of all the limbs in the two groups was analyzed by CTA.Results In the fPAES group,the medial head of gastrocnemius muscle moved outward in all the limbs,93%(13 limbs) were displaced outside of the popliteal artery,and all of the popliteal artery were relocated to a deeper position.In the control group,only in 21 limbs(12%),the medial head of gastrocnemius muscle completely started from the "posterosuperior medial femoral condyle",the so-called standard anatomical position.The position relationship between the medial head of the gastrocnemius muscle and popliteal artery was abnormal in 21%(38 limbs),and the depth popliteal artery was abnormal in 38%(68 limbs).Conclusions The outward displacement of the medial head of the gastrocnemius muscle is common in general population.Functional PAES might be a result of obvious anatomical outward displacement which could cause entrapment.The medial head of the gastrocnemius muscle displacing outside of the popliteal artery and popliteal artery shifting to a deeper position are two useful observational indices for fPAES.