阔筋膜张肌皮瓣的血管和神经供给

解剖、观测了50具成年尸体的100例阔筋膜张肌及其皮区的血管和神经。另7具尸体用血管造影、墨汁注射等方法进行了研究。阔筋膜张肌的主要营养动脉全部来自旋股外侧动脉的升支。升支的长度平均为47.1±0.8毫米,起始处的外径为3.3±0.8毫米,肌门处的外径为2.0±0.04毫米。升支起始处距腹股沟中点的距离为61.8±1.7毫米。肌门距髂前上棘的距离为84.4±1.1毫米。复盖阔筋膜张肌及髂胫束的皮肤动脉,主要来自阔筋膜张肌的肌皮动脉。此外,尚有来自旋髂浅动脉、股外肌的肌皮动脉以及膝上外侧动脉的皮支。它们在股前外侧部还与股直肌的肌皮动脉、从缝匠肌深面浅出的皮动脉以及第一、第二穿动脉的皮支相互吻合,形成筋膜面血管网和皮下血管网。支配阔筋膜张肌的神经来自臀上神经下支。它经臀中肌的深面,在髂峭下方47.7±1.9毫米处,从肌的后缘进入肌的深面。神经干粗为1.3±0.2毫米。本文对阔筋膜张肌皮瓣、肌筋膜瓣、筋膜皮瓣、肌骨皮瓣和具有感觉功能的肌皮瓣作了讨论。     

阔筋膜张肌肌皮瓣解剖学研究

1.阔筋膜张肌全长400mm,肌腹与腱膜长度之比为3:5。2.阔筋膜张肌肌皮瓣的血液主要由旋股外侧动脉升支供应(占92%),该动脉于长37mm,外径2.6mm。该动脉在叽外的分支为上,下二支,肌支干长17mm,外径1.20mm。3.阔筋膜张肌血供动脉常有1—2支伴行静脉,血管外径略粗于动脉。4.阔筋膜张肌的运动神经是臀上神经下支,神经干长125mm,宽度为1.50mm。5.阔筋膜张肌肌皮瓣的感觉神经是股外侧皮神经和叻下神经外侧皮支,偶有生殖股神经股支参与,皮神经宽度为1.60mm。6.阔筋膜张肌肌皮瓣的皮动脉分布广泛,在股外侧上份较为丰富(占63%),皮动脉外径在0.50～0.80mm 之间。     

阔筋膜张肌的血供及应用解剖

国内外学者曾为小腿溃疡进行阔筋膜张肌肌皮瓣游离移植和肌筋膜瓣转位加固股骨颈骨折修复成功 ;对该肌的血供应只提到旋股外侧动脉 ,还未见臀上 (下 )动脉的报道 ;而本文对阔筋膜张肌的长度及血供的来源、外径均做了解剖学测量。为临床提供修复巨大型腹股沟斜疝和幼儿巨大型脐疝修补、取材提供可靠的解剖学依据。1　材料和方法取 15具 (男 8、女 7)整尸标本 ,在 30侧经髂总动脉灌注红色乳胶的成人盆部及下肢标本 ;解剖观察臀上 (下 )动脉和旋股外侧动脉的走行、分布 ;并用游标卡尺对血管外径进行测量。2　结果2 .1　旋股外侧动脉的起源　该…     

旋股外侧动脉升支阔筋膜张肌支髂骨瓣的解剖学研究及临床意义

目的 :探讨带旋股外侧动脉升支阔筋膜张肌支髂骨瓣的解剖及应用要点。方法 :在 2 5侧经动脉灌注红色乳胶的成人下肢标本上 ,重点观测旋股外侧动脉升支阔筋膜张肌支的走行、分支、发出点和外径等。结果 :旋股外侧动脉升支的阔筋膜张肌支上行支发出点距髂前上棘平面 7.1± 2 .3cm ,外径 1.2± 0 .8mm ,该支又分出 2～ 3支外径在 0 .3mm～ 0 .5mm的小分支从阔筋膜张肌后份进入肌质 ,上行至肌起始处达髂骨 ;其下行支发出点距髂前上棘平面 7.9± 1.8cm ,外径 1.3± 0 .8mm。结论 :旋股外侧动脉升支阔筋膜张肌支髂骨瓣具有手术可行性和实际应用价值     

阔筋膜张肌、髂胫束及其皮肤血管的显微解剖

本文在30例成人尸体下肢血管内注入硫酸钡乳胶混合液。以 X 线片及三倍放大镜观察阔筋膜张肌、髂胫束及皮肤的血管,并测其口径及长度。阔筋膜张肌长14.27±0.33cm;宽3.05±0.16cm;厚1.23±0.79cm。髂胫束长28.46±0.52cm;宽5.03±0.23cm;厚0.77±0.06cm。阔筋膜张肌的主要动脉为旋股外侧动脉升支的直接延续(90.00%±5.47)。升支的口径为2.22±0.09mm;长度为2.70±0.22cm。主要动脉的口径为1.64±0.05mm;长度为2.71±0.24cm。主要动脉与升支长度之和即为阔筋膜张肌血管蒂的长度(5.55±0.32cm)。髂胫束由束皮动脉供应,多来自股外侧肌支。阔筋膜张肌及髂胫束范围内的皮肤由纯皮动脉、肌皮动脉穿支及束皮动脉供应。纯皮动脉多来自旋髂浅动脉,其口径为0.94±0.05mm;肌皮动脉穿支多来自阔筋膜张肌主要动脉,其口径为0.54±0.02mm;束皮动脉口径为0.84±0.03mm。上述三种皮动脉在皮下有丰富的相互吻合。     

阔筋膜张肌的血供及应用解剖

为临床带血管蒂修复巨大型腹股沟斜疝和幼儿巨大型脐疝术提供解剖学基础。在 30侧经髂总动脉灌注红色乳胶的成人下肢标本上 ,解剖观察了臀上、下动脉和旋股外侧动脉的走行、分布及外径。结果 :阔筋膜张肌的血供主要由旋股外侧动脉升支供应 ,占 76 .75 % ,其次是升支和横支者占 81.6 5 %。结论 :阔筋膜张肌的血供丰富、来源广泛 ;旋股外侧动脉有四种不同类型的分支营养阔筋膜张肌。臀上、下动脉深支的终未分支也参与营养该肌     

阔筋膜张肌与髂胫束的形态学研究及临床应用

阔筋膜张肌位于大腿上部前上外侧,起自髂前上棘,肌腹包于两层阔筋膜内,至大腿上中1／3交界处移行于髂胫束,后者止于胫骨外侧髁。自Wangensteen（1934）最早用阔筋膜和髂胫束修补腹股沟疝及腹壁缺损以来,国内外学者对阔筋膜张肌和髂胫束的形态与临床应用进行了大量研究,本文就阔筋膜张肌与髂胫束的形态学及临床应用研究进展综述如下。一、形态与功能研究阔筋膜张肌早在Vesaluis时（1552）就已被认识。十八、十九世纪有关阔筋膜张肌的功能吸引了许多解剖学家的兴趣。Winslow（173）认为该肌可使大腿旋内,并正确描述了该肌以部分腱纤…     

肱三头肌长头重建肩外展功能的应用解剖

目的研究肱三头肌长头血管神经蒂特点为以其重建肩外展功能提供解剖学基础。方法对44侧固定尸体的肱三头肌长头肌肉起点及血管神经蒂进行解剖与测量。结果肱三头肌长头起点背侧为肌性,腹侧为腱性,腱性起点长度(9.9±1.5)cm,宽度(2.4±0.4)cm。神经支配来自桡神经的分支,可分离长度(6.8±2.7)cm,直径(2.0±0.4)mm。血供来自①肱动脉肱三头肌支,长度(3.4±1.4)cm,外径(2.0±0.3)mm;②肱深动脉的分支,长度(2.5±0.9)cm,外径为(1.6±0.5)mm,分离至肱动脉长度为(3.9±1.3)cm。血管神经蒂以多级分支为主。结论依据肱三头肌长头及其血管神经蒂的特点,可作为肩外展功能重建术中的动力肌。     

足背短肌的应用解剖

本文用手术显微镜及测微器在50侧(男30、女20)成人尸体的标本上对伸(足母)短肌和伸趾短肌的形态.血供和神经支配进行解剖与测量.伸(足母)短肌的长54.8±0.90mm,宽15.90±0.44mm厚3.46±0.18mm;伸趾短肌的长65.65±1.58mm,宽19,46±0.51mm,厚3.43±0.19mm.血供主要来自跗外侧动脉,其起点处的外径1.72±0.09mm,入肌处的外径0.82±0.06mm,可游离的长度24.85±1.41mm;肌肉由腓深神经分支支配.本文还讨论了该肌瓣的临床应用及作为供体时应注意的问题.     

肱三头肌外侧头神经肌支和血供的应用解剖

目的 :为肱三头肌外侧头的神经肌支移位和游离肌皮瓣移植提供解剖学基础。方法 :在 3 0侧成人上肢标本上对肱三头肌外侧头的神经肌支和血管进行详细解剖观测。结果 :外侧头肌支数 2～ 4支 ,一般为 3支。入肌部位位于大圆肌腱下缘 ( 5 .3 1± 2 .0 1)、( 6.0 6± 1.2 1)、( 5 .96± 1.0 )cm ,横径分别为( 1.4± 0 .5 )、( 1.2± 0 .2 )、( 1.9± 0 .9)mm。肌皮神经肱二头肌平均 2个肌支 ,入肌部位分别在大圆肌下缘以下 ( 4 .2 1± 1.66)和 ( 4 .5 8± 1.3 2 )cm ,横径为 ( 1.4± 0 .6)和 ( 1.2± 0 .8)mm。腋神经入肌部位在大圆肌下缘以上发出。肱三头肌外侧头血供来源于肱深、旋肱后及部分近侧肌支 ,且均与肱深血管有关。结论 :肱三头肌外侧头肌支有足够长度和横径 ,在肌门处可无张力移位至肌皮神经肱二头肌支及部分腋神经肌支。以肱深血管为蒂的肱三头肌外侧头游离肌皮瓣是修复前臂肌肉皮肤缺损的良好供体     

阔筋膜张肌肌构筑和肌内神经的研究

目的通过对阔筋膜张肌构筑学和肌内神经分支分布的研究,为阔筋膜张肌的临床应用提供解剖学资料。方法大体解剖法、肌构筑法、改良Sihler′s肌内神经染色法。结果(1)阔筋膜张肌肌重(46.25±4.8)g,肌长(16.42±0.6)cm,肌纤维长(4.54±0.5)cm,羽状角0°,肌生理横切面积(9.65±0.74)cm2;(2)支配阔筋膜张肌的神经来自臀上神经下支,从肌的后上部入肌,入肌后向肌下部走行,分成前后两大支,前支主要支配肌前半部,后支主要支配肌后半部。结论 (1)阔筋膜张肌是扁肌,倾向于速度型构筑特征;(2)阔筋膜张肌肌内神经主要分布在肌中部。     

Blood supply of the tensor fasciae latae muscle

The tensor fasciae latae (TFL) muscle has been successfully harvested as a myocutaneous flap in reconstructive surgery. Reports on the vascular supply of this muscle, however, are incomplete or inconclusive. Therefore the arterial pattern was examined by dissection in 100 injected human cadaveric specimens. It was observed that whereas 67 muscles were supplied exclusively by a single vessel derived from the ascending branch of the lateral circumflex femoral (LCF) artery, 13 were supplied by a secondary vessel derived from the same branch, while 20 muscles were supplied by two vessels, the larger one arising as before and the smaller from the descending branch of the LCF. Our observations reveal that although the majority of TFL muscles are clinically Type I (one vascular pedicle) according to the classification of Mathes and Nahai (1981), 20% are actually Type II (major and minor vascular pedicles). Clin. Anat. 11:236–238, 1998. © 1998 Wiley-Liss, Inc.     

髂胫束的应用解剖

目的：研究并确定髂胫束的形态和组织结构及体表投影等，为临床用应提供依据。方法：于尸体上观测髂胫束前后区各部的长、宽、厚并做组织切片观察。结果：髂胫束之膜性结构上界约平臀横纹或其上下10mm范围内，前后界分别位于髂前上棘和大转子尖与胫骨外侧髁结节前后缘连线所构成的区域内。左右侧测量值均无明显差异。上述区域以外的阔筋膜均较薄。结论：在髌骨上缘水平以下之髂胫束前后区是阔筋膜最厚处，与胫骨结节附着亦最紧密，该处用于膝交叉韧带等韧性较大的腱性结构损伤的修复材料较理想。     

Skeletal muscle susceptibility to clofibrate induction of lesions in rats

Morphological changes induced by clofibrate in type-1 predominant soleus, type-2 predominant tensor fasciae latae, and type-1 and -2 mixed biceps femoris muscles and diaphragm in rats were investigated. Administration of the agent at 500 or 750 mg/kg/day by oral gavage for 14 or 28 days caused lesions in the soleus muscle and diaphragm, bur no changes in the tensor fasciae latae and biceps femoris muscles. In soleus muscle, vacuolation of muscle fibers was observed in all animals treated with clofibrate, and degeneration of muscle fibers and infiltration of leukocytes were noted at 750 mg/kg/day. In diaphragm, vacuolation of muscle fibers was also observed in all animals treated with clofibrate, and these lesions were located in type-1 skeletal muscles densely stained with NADH-TR. The vacuoles seen in soleus muscle and diaphragm were positive for oil red O staining. In addition, increase of lipid droplets and mitochondrial hypertrophy was seen in soleus muscle, ultrastructurally. These data suggest that sensitivity to clofibrate-induced muscle toxicity differs among muscles, with type-1 fibers being susceptible.     

Effects of Log-Rolling Position on Hip-Abductor Muscle Activation During Side-Lying Hip-Abduction Exercise in Participants With Gluteus Medius Weakness

ContextWeakness of the gluteus medius and gluteus maximus is associated with a variety of musculoskeletal disorders. However, activation of synergistic muscles that are not targeted should be considered when prescribing side-lying hip-abduction (SHA) exercises. Log-rolling positions may affect hip-abductor activity during SHA.ObjectiveTo determine the effects of log-rolling positions on gluteus medius, gluteus maximus, and tensor fasciae latae activity during SHA in participants with gluteus medius weakness.DesignControlled laboratory study.SettingUniversity research laboratory.Patients or Other ParticipantsTwenty-one participants with gluteus medius weakness.Intervention(s)Three types of SHA were performed: frontal-plane SHA in neutral position (SHA-neutral), frontal-plane SHA in anterior log-rolling position (SHA-anterior rolling), and frontal-plane SHA in posterior log-rolling position (SHA-posterior rolling).Main Outcome Measure(s)Surface electromyography was used to measure hip-abductor activity. One-way repeated-measures analysis of variance was calculated to assess the statistical significance of the muscle activity.ResultsThe SHA-anterior rolling showed greater gluteus medius and gluteus maximus activation than the SHA-neutral (P = .003 and P < .001, respectively) and SHA-posterior rolling (P < .001 and P < .001, respectively). The SHA-neutral demonstrated greater gluteus medius and gluteus maximus activation than the SHA-posterior rolling (P < .001 and P = .001, respectively). The SHA-anterior rolling produced less tensor fasciae latae activation than the SHA-neutral (P < .001) and SHA-posterior rolling (P < .001). The SHA-neutral showed less tensor fasciae latae activation than the SHA-posterior rolling (P < .001).ConclusionsThe SHA-anterior rolling may be an effective exercise for increasing activation of the gluteus medius and gluteus maximus while decreasing activation of the tensor fasciae latae in participants with gluteus medius weakness.     

带臂外侧上皮神经及其营养血管筋膜皮瓣的应用解剖

目的:为带臂外侧上皮神经及其营养血管筋膜皮瓣提供解剖学基础.方法:32例经灌注红色乳胶的成人上肢标本,对臂外侧上皮神经及其营养血管等进行了较详细的应用解剖学研究.结果:臂外侧上皮神经在均由腑神经发出,起点横径为1.5±0.4mm,在三角肌深方斜向外下3.6±1.1cm从该肌后缘中1/3浅出肌间隔,分为上支和下支,分布于三角肌后部、外侧部和臂外侧上部.该神经的营养血管起源于旋肱后动脉,起点外径为0.9±0.4mm;其行程、分支和分布均同在神经,供血范因为14.8×9.8cm~2,并与周围的皮动脉存在丰富吻合.结论:带臂外侧上皮神经及其营养血管筋膜皮 瓣可视受区需要设计成游离瓣或旋转瓣,用于修复邻近部位、手或颌面部缺损.     

枕动脉的临床解剖学

在44例成人头颅材料上对枕动脉走行分三段调查.第一段位于颈动脉三角内.长2.9±0.4cm,分出脑膜支、肌支;第二段位于胸锁乳突肌和头夹肌深面,长5.8±0.5cm,分出乳突支、耳支、降支、颅后支,第三段是枕动脉浅出点至上横线的头皮支.长11.7±1.3cm,一般分为Ⅱ主支型(占75%).枕动脉起始部外径3.1±0.2mm;浅出点(A点)外径2.8±0.4mm;头皮支的B点外径2.1±0.2mm、C点1.7±0.4mm、D点2.0±0.3mm 、E点1.6±0.4mm.对头皮支的分型分布提出了体表定位方法.结合临床颅内、外动脉吻合术和动脉逆行插管术的应用进行了讨论.     

Defining the position of deep inguinal ring in patients with indirect inguinal hernias

A preliminary survey of surgeons of all grades in our hospital revealed confusion about the position of the deep inguinal ring. Standard teaching is that the deep inguinal ring is lateral to the femoral artery. The aim of this study was to define the position of the deep ring in patients undergoing elective inguinal hernia repair. Thirty consecutive male patients undergoing indirect inguinal hernia repair under local anaesthesia were studied. The following landmarks were marked on the patient with a felt pen: anterior superior iliac spine (ASIS), femoral artery (FA), deep inguinal ring (DR), pubic tubercle (PT) and pubic symphysis (PS). The distance of each point from the ASIS was measured in centimetres. The relation of the femoral artery to the deep inguinal ring was confirmed by palpation through the deep ring during surgery. The femoral artery was consistently identified midway between the anterior superior iliac spine and pubic symphysis (mid-inguinal point). The deep inguinal ring was located medial (22/30) or above (8/30) the femoral artery, but never lateral. The mean distances from the anterior superior iliac spine to the deep ring and femoral artery were 8.8 and 7.7 cm, respectively. Contrary to standard teaching, this study demonstrates that the deep inguinal ring lies medial, not lateral, to the femoral artery. This may clarify some of the variations in textbook anatomy, and explain the difficulty in distinguishing direct and indirect inguinal hernias pre-operatively.Presented at the Association of Surgeons of Great Britain and Ireland (ASGBI, April 2004 Harrogate)     

腹股沟区的应用解剖及其临床意义

目的为腹腔沟斜、直疝修补术提供理论基础,方法 用肉眼观察并应用游标卡尺测量腹股沟区有关结构。结果 腹内斜肌起始有四种类型,肌腱移行处呈现三种类型：腹横肌起始,腹股沟镰各有三种类型。腹股沟韧带平均长11．65cm,宽0．58cm;髂耻束平均长6．94cm,宽0．53cm。髂耻束并不恒定存在。腹内斜肌起于髂耻束者3例,占1．17％,腹横肌起于髂耻束者占10．7％。结论 观测值为临床疝修补术提供理论基础和实用数据。     

胎肝血管的解剖及其移植应用

目的观察胎肝的血管特点,探讨在临床带血管的胎肝移植的血管吻合的选择性。方法6～10个月胎龄的死胎33例于手术放大镜下原位解剖胎肝的附属血管,用直尺、卡尺和分割规测量附属血管的外径和长度。结果6～10个月胎龄的胎肝脐静脉的外径为(3.68±0.48)mm～(5.61±0.87)mm,长度为(36.12±4.58)mm～(50.97±7.68)mm;门静脉的外径为(2.31±0.43)mm～(4.16±0.65)mm,长度为(15.62±2.68)mm～(29.03±4.87)mm;肝固有动脉的外径为(1.67±0.82)mm～(2.32±0.98)mm,长度为(14.96±3.03)mm～(25.58±3.85)mm。脐静脉的外径较门静脉的外径粗(P<0.05);门静脉的外径较肝固有动脉的外径粗(P<0.05)。结论在胎肝移植前先结扎静脉导管,以脐静脉替代门静脉吻合,门静脉替代肝固有动脉吻合,更有利于吻合技术操作和供肝的双重血供,更有利于供肝发挥正常的功能。