左上肢掌长肌缺如伴有尺动脉变异一例报告

1、掌长肌及其肌腱缺如,掌腱膜近侧端附着在腕横韧带的浅面。2、尺侧浅动脉由腋动脉第三段分出,位置表浅,形成高位尺浅动脉。 3、骨间总动脉由肱动脉分出,肌支丰富,与正常的尺动脉在前臂的分支分布基本相同。4、在手背桡动脉除发一穿支,穿第一掌骨间隙与尺侧浅动脉的掌深支构成掌深弓外,还发一异常分支,继续下行,到达拇收肌下缘,在此处发出拇指尺侧动脉和食指桡侧动脉,然后绕过拇收肌下缘达手掌,与尺侧浅动脉的掌浅支吻合成掌浅弓。     

腕部动脉网的巨微解剖

在手术显微镜下,解剖观察了50侧用红色乳胶灌注动脉的成人上肢标本。共有12个动脉源参加腕部的动脉网。腕部动脉网在背侧有三个层次,掌侧有两个层次。位于腕关节囊掌侧和背侧的动脉网最为完整,是腕部动脉吻合交通的主要动脉网。腕背侧动脉网,主要由桡动脉腕背支、骨间前动脉背侧支及上穿动脉上支吻合形成。腕掌侧动脉网,主要由桡动脉腕掌支、骨间前动脉掌侧支和尺动脉腕背支参加。骨间前动脉在腕部与桡、尺两动脉均有广泛吻合,但从吻合管径和吻合数量看,则具有桡侧优势。前臂动脉干与手部动脉干之间,通过腕掌侧和背侧动脉网建立的侧副吻合,则显示背侧优势。腕部的动脉网,呈现多来源、多吻合、多层次的构筑特点,与多关节、多活动、多层次的腕部结构和功能相适应。 本文从形态学上讨论了,腕部桡、尺动脉两支或任何一支在急性或慢性阻断时,腕部动脉网代偿动脉干供应手部血液的可能性。     

中指背侧岛状皮瓣的解剖学及临床应用

通过对30只成人尸体手的显微解剖,发现中指背侧也可形成岛状皮瓣,其营养血管为第二掌背动脉。该动脉在鼻烟窝基底尺侧起自桡动脉腕背支,走行在第二骨间背侧肌表面的筋膜层中,在掌骨底远侧及掌指关节水平均与掌侧血管有吻合。该动脉供血可达中指背基节中远1/3交界处,两侧可达侧中线。皮瓣的静脉回流由两条伴行静脉完成,皮瓣神经为走行在皮下脂肪中的桡神经浅支。临床应用3例,均获成功。     

右前臂尺侧异常屈肌1例

在制作解剖教学标本过程中,于一成人女尸的右前臂掌尺侧发现1块异常小肌。 1 观察结果该肌呈条状,均以键起止,近端起于脓骨内上裸,远端止于钩骨部,位于尺侧屈腕肌与掌长肌之间,指浅屈肌的表面。肌纤维自内上     

腕尺管综合征的临床分析

腕尺管是尺神经走行于腕部尺侧骨性的纤维管道,腕尺管上口为豌豆骨近侧缘、腕掌侧韧带和腕横韧带围成,止于钩骨钩远端的部分,通过该管道的内尺神经受到各种因素的卡压引起感觉、运动功能障碍的症状和体征,称为腕尺管综合征[1]。本病在临床较少见到,腕部尺神经受压的原因很多,病因复杂,临床症状和体征复杂,常合并其他损伤。本文总结近年临床诊疗的病例如下。     

以肘网血管为蒂骨膜瓣的应用解剖

目的 :为以肘网血管为蒂骨膜瓣移位治疗肘关节周围骨折、骨不连提供解剖学资料 ,优化手术设计。方法 :在 3 4侧经动脉内灌注红色乳胶的成人上肢标本上观察肘关节周围非主干动脉的起源、走行、分布、吻合并测量其起点外径、长度及骨膜瓣可取面积。结果 :中副、桡侧副、尺侧上副、尺侧下副、桡侧返、尺侧返、骨间返动脉的起点外径均在 1mm以上 ;其中桡侧副、尺侧下副、骨间返动脉有骨膜支各供应肱骨下段外侧、肱骨下段内侧、尺骨上段背侧 ;桡侧副、桡侧返、骨间返动脉在肘关节桡侧有恒定的吻合 ,尺侧上副、尺侧下副、尺侧返动脉在肘关节尺侧有恒定的吻合。结论 :①肘网血管在肘关节桡、尺侧吻合恒定 ;②肘关节周围有 3个骨膜瓣供区 ;③各骨膜瓣供区的近端和远端至少有 1支肘网血管供应 ,可向近端或远端移位 ;④肘网血管为蒂骨膜瓣设计多样 ,应根据各骨膜瓣应用解剖要点选择使用     

带蒂尺骨远端移植修复腕掌部骨缺损的解剖学研究

解剖观察71只成人上肢标本发现,骨间背侧动脉不仅沿途发出7.35±2.60个皮支,供应前臂背侧皮肤,还在距尺骨茎突近端3.57±0.51cm,于骨间背侧动脉与骨间掌侧动脉背支的吻合弓附近,发出2.31±0.77个骨膜支,支配尺骨远端的血供。它的终末支在尺骨小头桡侧向远端行走.参与尺、桡动脉背支形成的腕背动脉网,以其远端终末支为血管蒂,成为带骨间背侧动脉蒂尺骨远端移植修复腕掌部骨缺损的解剖学基础。     

前臂背侧皮瓣血管的显微解剖及临床应用的研究

作者自1986年11月～1987年2月,对35具福尔马林保存尸体的上肢标本行动脉内红色乳胶灌注,在手术显微镜下解剖前臂背侧皮肤营养血管的分布情况。对8具新鲜尸体上肢行动脉内灌注铅丹油,然后取下前臂背侧皮肤、皮下组织及深筋膜行软X线照相,显示皮瓣内动脉分布情况。通过研究发现,前臂背侧皮肤有两条恒定轴型血管——骨间掌侧动脉     

第Ⅱ指蹼分叶岛状皮瓣血供的应用解剖

目的：研究第Ⅱ指蹼分叶岛状皮瓣的血供,为临床应用提供解剖学资料。方法：解剖６０例成人手的血管标本,进行肉眼观测。结果：第Ⅰ掌产级动脉供应食指背面烧侧皮肤,第Ⅱ掌背动脉供应食指尺侧及中指桡侧皮肤。两动脉的分支在食指背侧吻合成网。结论：第Ⅱ指蹼分叶岛状皮瓣由第Ⅰ、Ⅱ掌背动脉供应;带第Ⅰ或第Ⅱ掌背动脉血管蒂的分叶岛状皮瓣修复拇指成活率高,达９０．９％。     

腕部背侧血管蒂骨(膜)瓣的解剖学基础及临床意义

目的 :为腕部背侧带血管蒂骨 (膜 )瓣的设计提供解剖学基础。方法 :30侧经动脉内灌注红色乳胶的成人上肢标本 ,解剖观测了骨间前动脉、桡动脉和尺动脉的腕背支以及第 2 ,3掌背动脉的起始、走行、分支分布及吻合情况。结果 :①骨间前动脉腕背支始于桡骨茎突上 (6 .6± 0 .7)cm处 ,外径 (1.4± 0 .2 )mm ;②桡动脉腕背支起点距桡骨茎突 (1.2± 0 .3)cm ,外径为 (1.3± 0 .3)mm ;③第 2 ,3掌背动脉分别始于桡动脉腕背支和掌深弓的穿支 ,外径均为 (0 .8± 0 .2 )mm ;④尺动脉腕背支于豌豆骨上 (4 .1± 0 .6 )cm始于尺动脉 ,外径 (1.2± 0 .3)mm。上述动脉间相互吻合丰富 ,在手背形成动脉网 ,并发骨膜支分布尺、桡远端和掌骨。结论 :以上述动脉腕背支及第 2 ,3掌背动脉为蒂 ,可以设计不同的带血管蒂的骨 (膜 )瓣 ,用于邻近移位修复舟、月骨骨不连或骨坏死     

Clinics in diagnostic imaging (156). Golf-induced hamate hook fracture.

The wrist is a common site of injury and the most frequently injured body part among professional golfers. A 37-year-old, right-handed male golfer presented with pain at the ulnar aspect of his left palm, which grew worse after an initial traumatic impact from the golf club handle. There was tenderness over the hypothenar eminence of the left palm. Computed tomography of the left wrist showed an undisplaced fracture through the base of the hamate hook. The golf-induced hamate hook fracture was managed conservatively, with cessation of physical activity involving the left hand and wrist for eight weeks. The patient made a full recovery. Repetitive trauma, exacerbated by improper wrist motion, leads to typical wrist injuries affecting golfers, such as ulnar impaction syndrome, de Quervain’s disease, and tendinopathy affecting the flexor carpi ulnaris and extensor carpi ulnaris, all of which can be diagnosed on imaging.     

外固定支架治疗C型桡骨远端骨折45例疗效分析

目的：观察外固定支架治疗C型桡骨远端骨折的疗效。方法：临床运用外固定支架治疗C型桡骨远端骨折45例,分别在治疗前,治疗后2d、4周、8周测量桡骨远端掌倾角、尺偏角及桡骨短缩情况。结果：术后8周X线片影像学评价结果显示优33例,良7例,中5例,优良率为88．89％。术后12周腕部功能评定结果显示优35例,良6例,可4例,优良率为91．11％。结论：外固定支架能较好地恢复桡骨远端掌倾角、尺偏角及桡骨短缩,有利于C型桡骨远端骨折的功能恢复。     

An atypical anatomical variation of palmar vascular pattern

A complex variation in the pattern of blood supply to the palm of the hand was encountered during a routine dissection of a female adult cadaver. Findings were: (a) there was no communication between the superficial palmar branches of the radial and ulnar arteries (incomplete superficial palmar arch); (b) the superficial palmar branch of the radial artery coursed superficially to the thenar muscles supplying two common palmar digital arteries for adjacent sides of the thumb and index finger, thereby replacing the conventional arteria radialis indices; (c) the branch supplying the lateral side of the thumb was seen arising from the deep branch of the radial artery; (d) the superficial palmar branch of the ulnar artery supplied a branch to the medial side of the little finger, and two common palmar digital arteries for the adjacent sides of the little and ring fingers and ring and middle fingers, respectively. Familiarity with the variations in the vascular patterns resulting from a number of developmental errors remains the crucial issue for personnel engaged in reconstructive hand surgery, where these varied patterns act as pivotal points around which successful accomplishment of various advanced surgical procedures revolve.     

掌浅弓的应用解剖研究

目的 研究掌浅弓的形态学特征,为手掌血管损伤的修复或重建提供解剖学基础.方法 对20具成人尸体的40例手进行层次解剖,充分暴露掌浅弓,观察其类型、形状、对称性和分支.结果 ①类型:桡尺动脉型19例(47.5%),尺动脉型15例(37.5%),正中尺动脉型3例(7.5%),桡正中尺动脉型2例(5.0%),尺动脉掌深弓分支型1例(2.5%).②形状:单弓形20例(占50.0%),弧线形14例(占35.0%),鞍形4例(占10.0%),双弓形仅2例(占5.0%).③对称性:掌浅弓左右侧不称者16例,占40.0%;对称者24例,占60.0%.④分支:掌浅弓的分支有3～6条,34例(85.0%)发出小指尺掌侧动脉,22例(55.0%)发出3条指掌侧总动脉,13例(32.5%)发出4条指掌侧总动脉.结论 掌浅弓以桡尺动脉型为主,左右侧多对称,多呈单弓形状,分支3～6条.     

Clinical classification and treatment strategy of hamate hook fracture

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures,12 patients who suffered from hamate hook fractures were followed up retrospectively.According to the fracture sites and the prognosis,we classified the hamate hook fractures into 3 types.Type Ⅰ referred to an avulsion fracture at the tip of hamate hook,type Ⅱ was a fracture in the middle part of hamate hook,and type Ⅲ represented a fracture at the base of hamate hook.By the classification,in our series,only 1 fell into type Ⅰ,7 type Ⅱ,and 4 type Ⅲ.The results were evaluated with respect to the functional recovery,recovery time and the association among the clinical classification,pre-operative complications and treatment results.The average follow-up time of this group was 8.4±3.9 months.Two cases were found to have fracture non-union and both of them were type Ⅱ fractures.Six patients had complications before operation.Five cases were type Ⅱ fractures and 1 case type Ⅲ fracture.All the patients were satisfied with the results at the time of the last follow-up.Their pain scale and grip strength improved significantly after treatment.All the pre-operative complications were relieved.The recovery time of hamate hook excision was significantly shorter than that of the other two treatments.The incidences of both pre-operative complications and non-union in type Ⅱ fractures were higher than those in type Ⅰ and type Ⅲ fractures.It was concluded that,generally,the treatment effects with hamate hook fracture are quite good.The complication incidence and prognosis of the fracture are closely related to the clinical classification.Early intervention is critical for type Ⅱ fractures.     

“虎口区”动脉的起源及其临床意义

在１００例成人手标本上（其中４０例为动脉铸型标本）观测了虎口区动脉的来源及分布。虎口区供应拇、示指的动脉主要为拇指桡掌侧固有动脉、拇指尺掌侧固有动脉和示指桡掌侧固有动脉。根据这３条动脉的来源将虎口区的动脉分为５种类型，并讨论了其临床意义。     

掌浅弓的应用解剖

目的 为手掌血管损伤时,修复掌浅弓提供解剖学基础。方法 对60例成人掌浅弓的类型、形状、对称性和分支进行解剖观察。结果 掌浅弓分4型即尺动脉型、桡尺动脉型、正中尺动脉型、桡正中尺动脉型;以尺动脉型和桡尺动脉型为多见。掌浅弓有5种形状,即弧线形、单弓形、不完全形、鞍形和双弓形。弧线形与单弓形多见,不完全型、鞍型与双弓形少见。掌浅弓左右两侧对称性多见,占55．6％。掌浅弓的分支有3-6条,48例发出小指尺掌侧固有动脉,占80．0％。11例小指尺掌侧固有动脉与第3指掌侧总动脉共干,占18．3％。28例发出3条指掌侧总动脉,占46．7％。27例发出4条指掌侧总动脉,占45．0％。结论 手掌损伤修复重建掌浅弓时应充分注意掌浅弓的分型、形状、对称性和分支。     

经掌侧入路锁定加压钢板固定术与非手术治疗老年桡骨远端骨折的疗效对比

目的:观察比较经掌侧入路锁定加压钢板固定术与非手术治疗老年桡骨远端骨折的临床疗效.方法:选择71例老年桡骨远端骨折患者,根据患者意愿分为观察组37例和对照组34例,观察组采用经掌侧入路锁定加压钢板固定术治疗,对照组采用手法复位石膏外固定治疗,记录患者骨折复位及愈合情况,应用Cooney腕关节评分法评价腕关节功能.结果:观察组患者平均骨折愈合时间(12.1±2.4)周,对照组为(14.8±3.2)周,差异有统计学意义(P<0.05).两组患者治疗前掌倾角、尺偏角及桡骨缩短长度相似,差异无统计学意义(P>0.05);治疗6个月后,两组患者掌倾角、尺偏角及桡骨缩短长度较治疗前均好转,但观察组改善幅度较对照组更显著,差异有统计学意义(P<0.05);观察组患者Cooney腕关节评分中疼痛、活动范围、握力、屈曲/伸展活动度、功能评分方面均优于对照组,差异有统计学意义(P<0.05);观察组腕关节功能优良率94.6%,高于对照组的76.5%,差异有统计学意义(P<0.05).两组患者术后并发症发生率相似,差异无统计意义(P>0.05).结论:经掌侧入路锁定加压钢板固定术治疗老年桡骨远端骨折骨折愈合快,腕关节功能恢复好.     

外固定支架与钢板内固定治疗成人桡骨远端不稳定型骨折的临床研究

目的 探讨比较外固定支架与钢板内固定治疗成人桡骨远端不稳定型骨折的临床疗效和安全性.方法 将我院骨科收治的桡骨远端不稳定型骨折164例患者随机分为外固定支架组和钢板内固定组,分别采用闭合复位外固定支架进行固定和切开复位钢板内固定治疗进行固定,比较两组的Gartland-Werley临床功能评分、骨折复位情况和不良反应的发生情况.结果 钢板内固定组的优级比例为58.4%,显著高于外固定支架组的优级比例43.9%（P＜0.05）,相比于外固定支架组,钢板内固定组的复位情况较好,掌倾角和尺偏角的减少以及桡骨短缩均较少（P＜0.05）,两组的不良反应发生率相比差异无统计学意义（P＞0.05）.结论 钢板内固定可以恢复关节面的平整,实现骨折处的良好对位,对恢复掌倾角和尺偏角效果较好,对预防桡骨短缩、恢复腕关节功能具有良好的临床疗效,患者术后生活工作能力显著增强,临床疗效优,患者和家属的满意度高,值得临床进一步推广使用.