第1跖骨颈部跖侧动脉分布及吻合的临床解剖研究

目的:研究足底第1跖骨颈部附近的动脉吻合特点,为临床涉及该部位动脉的手术提供解剖学依据。方法:随机选取12侧成人足标本,动脉乳胶灌注,制作血管显微解剖标本,对第1跖骨颈部跖侧的动脉分布及吻合进行观察。结果:在第1跖骨颈部跖侧,由第1跖底动脉向胫侧和腓侧分为两支,两者与第1跖底动脉主干呈‘Y'型分布。两个支在长屈肌腱下,分别向胫侧和腓侧分为上行支和下行支,两侧的上行支和下行支分别与各自的发起动脉又各自形成一个‘Y'型。以上三者相互联系形成立体型的"3Y吻合"。第1跖骨中远1/3交界附近,还有第1跖骨胫侧动脉自第1跖底动脉发出,该动脉也分为上行支和下行支,形成第4个"Y",考虑到该处则共形成"4Y吻合"。结论:第1跖骨颈部跖侧的动脉吻合的参与血管较多,结构较复杂,本文中作者引入"3Y吻合或4Y吻合",能够较形象地描述该处的动脉结构特点。

Clinical anatomy on distribution and ansstomosis of arteries around plantar side of the 1st metatarsal neck

Objective:To study the course and anastomosis of arteries around the plantar side of the 1st metatarsal neck, and provide anatomical guides for clinical treatments involving the arteries around this area. Methods:12 adult foots were perfused with red latex to observe the arterial distribution and anastomosis around the plantar side of the 1st metatarsal neck through microdissection. Results:The 1st plantar metatarsal artery diverged into tibial and fibular branches at the plantar side of the 1st metatarsal neck, and formed a "Y" shape with the 1st plantar metatarsal artery. Both tibial and fibular branches gave ascending and descending branches under the tendon of flexor hallucis longus respectively. Other two 'Y' structures were formed among above branches and intercommunicated with the first "Y" to form a three-dimensional "3Y anastomosis". The 1st tibial metatarsal artery originated from the 1st plantar metatarsal artery at the junction of the intermediate and distal 1/3 segment of the 1st metatarsal bone, which also diverged ascending and descending branches, and joined the anastomosis of above arteries to form the forth "Y anastomosis" around the area. Conclusions:The vascular anastomosis of arteries around the plantar side of the 1st metatarsal neck is complicated. "4Y or 3Y anastomosis" can describe this feature precisely.