逆行腓骨肌肌皮瓣设计的解剖学研究

目的　为逆行腓骨肌皮瓣的设计与临床应用提供解剖学依据。 方法 新鲜下肢标本20侧,动脉灌注红色乳胶,解剖观测腓动脉、腓骨长肌、腓骨短肌及其表面皮肤与营养血管的的起始、走行、分支、分布的情况;新鲜标本2具,动脉灌注乳胶、氧化铅混悬液,CT扫描后三维重建小腿与足部血管。 结果 腓动脉起始外径(3.7±0.7) mm,多条分支供给比目鱼肌、 长屈肌、腓骨长、短肌及表面皮肤。腓动脉穿支的血管蒂可游离长度为(3.5±1.3) cm。腓动脉终末穿支在胫腓骨骨间膜中穿出,外径(1.2±0.4)mm,分为升支和降支。腓骨短肌肌腹的上部有一支较粗的腓浅动脉发自胫前动脉,向前穿骨间膜行于腓骨长肌与小腿前群肌之间,管径(1.8±0.5) mm,行向下营养腓骨短肌、腓浅神经和小腿前外侧部皮肤。 结论 以腓动脉中、下部穿支或终末穿支与其它血管的吻合部为蒂,可以设计切取逆行腓骨长、短肌肌皮瓣,修复小腿下部及足背部软组织缺损。     

远端蒂腓浅神经营养血管肌皮瓣的解剖与临床应用

目的探讨腓浅神经营养血管为蒂的肌皮瓣修复小腿远端及足踝部皮肤软组织缺损伴骨缺损慢性骨髓炎的解剖学依据及其临床应用效果。方法对30侧成人下肢灌注标本进行解剖,系统观测腓浅神经及其营养血管的来源、走行、分布、吻合及外径;3侧成人新鲜下肢标本墨汁灌注,观测腓浅神经营养血管的墨染范围;在此基础上,自2009年6月以来,应用远端蒂腓浅神经营养血管肌皮瓣修复小腿远端及足踝部皮肤软组织缺损伴骨缺损慢性骨髓炎者12例。结果腓浅神经营养血管发自胫前动脉穿支,其血管在其神经束间及神经旁相互吻合构成丰富的血管网,并借分支与皮下筋膜血管网沟通,并与腓骨长肌、趾长伸肌的肌支有恒定的吻合,营养筋膜皮肤。12例肌皮瓣的肌肉面术中可见渗血活跃,血供良好,皮瓣均成活,术后3~6个月随访12例肌皮瓣均存活,慢性骨髓炎治愈,外形满意。结论腓浅神经营养血管的肌皮瓣转位修复小腿远端及足踝部特殊创面是较佳的选择,该肌皮瓣具有血供可靠,预后良好等优点。     

吻合血管腓骨及腓骨长肌移植的应用解剖

在51例成年人下肢尸体标本和6例下肢血管铸型标本上,对腓骨和腓骨长肌的形态、血管和神经进行了研究。提出以腓血管或胫前血管和支配腓骨长肌的神经为吻合血管神经蒂,讨论分析了腓骨与腓骨长肌移植的临床应用的有关问题。     

足背皮瓣与足外侧或外踝上哑铃状联合皮瓣设计的解剖基础

目的:为手部复杂外伤并两处皮肤缺损及深部组织损伤外露的修复提供理想的皮瓣供区.方法:40侧动脉灌注红色乳胶的成人下肢标本,解剖观测胫前血管、腓血管穿支降支在踝前的分支、分布、外径及其远端吻合情况.结果:胫前动脉在踝间或踝上向外侧恒定地发出外踝前动脉.根据胫前动脉外踝前支的分出位置、粗细及与腓动脉穿支降支的吻合情况,可将其分成以下四型.两主干血管吻合后下行经外踝前至足背外侧与跗外侧动脉吻合,沿途发出皮支营养胫前踝上和足背外侧.结论:可以在形成以胫前血管为蒂的足背皮瓣同时,以胫前血管的外踝前动脉为血供设计足外侧或外踝上联合皮瓣应用.     

腓浅血管蒂腓骨移植的应用解剖

在４０侧灌注红色乳胶的成人下肢标本上，对腓浅血管的起始、走行和分支进行了解剖观测，结果显示：腓浅动脉始于胫前动脉，外径１．４±０．４ｍｍ。在肌间隔内，动脉分出１～３支外径为０．９±０．２ｍｍ的肌骨支，分布腓骨头及颈以下腓骨体中上段骨膜，并与其它来源的腓骨膜支构成动脉网，有形成以腓浅血管为蒂的腓骨移植，从而为腓骨移植增加一种可供选择的新血管蒂。临床应用２例，全部成活。     

双侧腓浅动脉纤细1例

男性尸体标本，年龄约50岁，身长170cm，双下肢无畸形及发育异常。解剖下肢时发现其双侧腓浅动脉起始于胫前动脉，起点距腓骨小下7．2cm，外径0．2mm。该血管沿趾长伸肌与腓骨长短肌之间下行，沿途发出3支外径约0．1mm的吻合支(附图)，与胫后动脉穿支吻合之后，进入皮下，彼此间吻合形成皮下动脉网。     

带骨骺的儿童腓骨移植应用解剖学

解剖观察了70侧的儿童腓骨上骨骺的动脉来源、分布和吻合情况。其血供来源共见7种,胫前返动脉和腓浅动脉的腓骨头支是营养骨骺的重要血管。带骨骺儿童腓骨移植应以胫前动脉为血管蒂,腓骨体移植仍以腓血管为蒂。     

腓血管蒂比目鱼肌皮瓣逆行转位修复术的应用解剖

目的：为以腓血管为蒂比目鱼肌皮瓣逆行转位修复小腿中、下段组织缺损提供解剖学基础。方法：在３３侧经动脉灌注乳胶的下肢标本及６侧动脉铸型下肢标本上,解剖观测比目鱼肌形态,腓动脉比目鱼肌支的分布及腓动脉与胫前、后动脉之间的吻合。结果：腓动脉发出１～４条比目鱼肌支,外径２．０±０．５（１．０～３．８）ｍｍ,由其发出至皮肤的血管在比目鱼肌内或沿肌间隔穿行,穿出点在腓骨头下９．９±３．０ｃｍ,分布范围１６ｃｍ×９ｃｍ。腓动脉下端与胫前、后动脉间有丰富的吻合支和粗大的交通支,最近端交通支距内、外踝连线５．５±０．８（３．６～７．４）ｃｍ,外径１．２±０．３ｍｍ。结论：以腓血管为蒂可以形成比目鱼肌皮瓣;该瓣逆行转位可修复小腿中下段缺损,具有血供可靠、损伤小、操作简单的优点     

吻合血管腓骨及(足母)长屈肌移植的应用解剖学

在50具(100侧)成年人尸体标本上,对吻合血管的腓骨和(足母)长屈肌复合瓣移植的应用解剖学进行了研究。这个复合组织瓣以腓血管及其伴行的胫神经(足母)长屈肌支为吻接的血管神经蒂,腓动脉外径3.7mm,(足母)长屈肌神经支横径1.6mm。     

腓肠神经-小隐静脉营养血管远端蒂复合瓣的解剖学研究

目的:为腓肠神经-小隐静脉营养血管远端蒂复合瓣设计提出解剖学依据.方法:30侧经动脉灌注红色乳胶成人下肢标本,解剖观测腓动脉肌间隔穿支、腓肠外侧动脉肌皮穿支与腓肠神经-小隐静脉、腓肠肌外侧头、比目鱼肌以及腓骨营养血管的关系;小隐静脉浅深交通支.结果:腓动脉肌间隔穿支6～10支,外径0.5～1.6 mm,最远的动脉穿支距外踝尖上(1.0±1.3)cm,外径(0.6±0.2)mm.穿支分出骨膜动脉、肌支,营养腓骨和比目鱼肌外侧半.穿支穿深筋膜时,发深筋膜支、皮支、皮神经浅静脉血管,构成腓肠神经-小隐静脉营养血管链.腓肠外侧动脉发2～5支外径0.2～1.2 mm肌皮穿支,营养腓肠肌外侧头及相应区域皮肤.小隐静脉浅深交通支距外踝尖上(3.4±0.9)cm,外径(1.7±0.5)mm.结论:腓肠神经-小隐静脉营养血管与肌、骨、皮营养血管同源,以腓动脉的肌间隔动脉终末穿支远端蒂复合瓣,旋转点近外踝尖平面,可覆盖前足创面.     

人腓总神经及其分支功能束定位与定量研究

目的探讨人腓总神经及其功能束的定位与定量情况。方法取20侧成人尸体腓总神经,采用Kamovsky-Roots乙酰胆碱酯酶组织化学法进行染色,并对其分支走形、数量进行统计学分析。结果切片内可见躯体感觉神经、躯体运动神经、γ-薄髓神经神经、交感节后无髓纤维。腓总神经、腓深神经和腓浅神经的躯体运动束主要位于神经断面的内下象限、外侧和后内侧;躯体感觉束主要位于神经断面的外上象限、后外侧和前内侧。腓浅神经纤维束及其各种神经纤维数量都比腓深神经多（P〈0．05）。结论腓总神经及分支内感觉纤维与运动纤维相互混合,且存在同种纤维分区聚集现象。     

腓总神经与腓骨颈的关系及其小腿各肌支的解剖学研究

目的明确腓总神经与腓骨颈的关系以及小腿各肌支的解剖学特征。方法取成人下肢标本40例,在肉眼及放大镜下解剖,观察腓总神经与腓骨颈的关系以及腓总神经各肌支的数目及走行,以腓骨头最突出点为测量起点,测量腓总神经绕腓骨颈处至腓骨头最突出点的距离;测量各肌支的发出点、入肌点的高度,并作统计学分析。结果腓总神经绕腓骨颈处至腓骨头最突出点的距离,左、右侧分别为(1.64±0.36)cm和(1.58±0.34)cm。各肌支的数目不等,其中胫骨前肌支数目最多,腓骨短肌支和跗长伸肌支的数目较少。40例标本中,腓总神经均穿行于腓骨颈部骨一筋膜管。结论腓总神经在绕腓骨颈处均穿行于骨一筋膜管。提示:这可能是导致腓总神经卡压综合征的主要原因之一;不同肌肉的神经肌支数目差别较大,与其所支配肌肉的结构、功能有关。     

Anatomical considerations of the deep peroneal nerve for biopsy of the proximal fibula in Thais

The present research aims to study the anatomical relationship between the deep peroneal nerve and the neighboring structures in the proximal fibula of Thais, with special regard to define the boundaries of a “safe” area when performing a biopsy of the proximal fibula. The proximal parts of 118 legs of 59 formalin‐embalmed adult cadavers (31 males, 28 females) were investigated. The distance from the apex of the fibular head to the point of origin of the deep peroneal nerve, the distance from the most lateral prominence of the fibular head to the anterior intermuscular septum, and the angle between the deep peroneal nerve and the fibula axis were measured. The results showed that the mean distances from the apex of the fibular head to the point of origin of the deep peroneal nerve was 28.4 ± 4.8 mm and from the most lateral prominence of the fibular head to the anterior intermuscular septum was 14.9 ± 2.0 mm. The mean angle between the deep peroneal nerve and the fibular axis was 28.1° ± 7.2°. In conclusion, these findings suggest that a “safe” area for bone biopsy in the proximal fibula of Thais is palpable anterior to the fibular head and downward laterally, not lower than 28 mm or 8% of the fibular length and from the most lateral prominence transverse medially not further than 14 mm. The inferior boundary of this area is an oblique line of the deep peroneal nerve about 28° from the fibular axis. Clin. Anat. 22:256–260, 2009. © 2008 Wiley‐Liss, Inc.     

小腿前外侧部桥式瓣的血供依据及临床应用

小腿前内侧缺乏肌肉覆盖,易引起胫骨外露。我们根据小腿前外侧皮肤血供特点,设计了双向供血桥式瓣,向内推移覆盖裸露胫骨12例,获得较好效果。此法优点:①若此瓣一端血供障碍,另一端正常时,仍能成活;②皮瓣切取范围大,本组最大为26×7cm;③血管表浅,解剖恒定,手术容易,利于推广。     

Relationship of the common peroneal nerve and its branches to the head and neck of the fibula

The common peroneal nerve (CPN) lies on the neck of the fibula, which forms the floor of the so-called 'fibular tunnel.' The tunnel entrance is a musculo-aponeurotic arch derived from the soleus and peroneus longus muscles and it is here that the CPN is commonly compressed in cases of peroneal nerve palsy. This study aims to define the relationship of the CPN and its branches to the apex of the head of the fibula and to the tunnel, with special regard to possible sites of entrapment. The distances from the apex of the fibula to the opening of the fibular tunnel, the CPN bifurcation, and the exit point of the deep peroneal nerve (DPN) from the tunnel, were measured in 30 legs to ascertain possible sites of entrapment. The angle that the CPN subtended with the long axis of the fibula was measured to gauge the range of positions of the CPN at the neck of the fibula. An unyielding musculo-aponeurotic fibular arch at the entrance to the fibular tunnel was confirmed in all specimens. The DPN exited through a crescentic opening in the anterior intermuscular septum in all cases and no DPN branches were found in the lateral compartment in any specimen. The mean (+/-SD) distance from the apex of the head of the fibula to the opening of the fibular tunnel was 3.2 +/- 1.0 cm, to the CPN bifurcation was 3.8 +/- 0.9 cm, and to the DPN exit point was 7.0 +/- 1.5 cm. The mean angle subtended anteriorly from the long axis of the fibula by the CPN was 18.9 +/- 9.0 degrees. We recommend further study of the mean distances and reference angle in relation to fibular landmarks, for use in possible minimally invasive surgical procedures to decompress the fibular tunnel.     

The consistent presence of the human accessory deep peroneal nerve

Twenty-four human legs were dissected macroscopically to study the morphological details of the accessory deep peroneal nerve. This nerve arose from the superficial peroneal nerve and descended in the lateral compartment of the leg, deep to peroneus longus along the posterior border of peroneus brevis. Approaching the ankle joint, this nerve passed through the peroneal tunnels to wind around the lateral malleolus; it then crossed beneath the peroneus brevis tendon anteriorly to reach the dorsum of the foot. The accessory deep peroneal nerve was found in every case examined and constantly gave off muscular branches to peroneus brevis and sensory branches to the ankle region. In addition, this nerve occasionally had muscular branches to peroneus longus and extensor digitorum brevis, and sensory branches to the fibula and the foot. The anomalous muscles around the lateral malleolus were also innervated by this nerve. Neither cutaneous branches nor communicating branches with other nerves were found. The present study reveals that the accessory deep peroneal nerve is consistently present and possesses a proper motor and sensory distribution in the lateral region of the leg and ankle. It is not an anomalous nerve as has previously been suggested.     

腓总神经压迫综合征的解剖学研究

在62侧成人下肢标本上观察了腓总神经穿行的腘窝外侧沟和腓骨长肌纤维拱的形态。拱的入口在腓骨头尘下方1.8cm,拱长2.4cm,属全腱性的拱仅占8.1％。对腓总神经的主要分支部位作了测量,这些数据对腓总神经压迫综合征的诊断和治疗有参考意义。     

Position of the fabella relative to the path of the common peroneal nerve across the lateral head of the gastrocnemius muscle

The fabella is an inconstant sesamoid bone located in the origin of the lateral head of the gastrocnemius muscle. The presence of a fabella has been associated with a number of pathologies including compression injury of the common peroneal nerve (CPN) as it crosses the lateral head of the gastrocnemius. This study was designed to determine the incidence of fabellae and the geometric relationship of the fabella to the CPN using anatomical dissection. In the 78 specimens examined, the incidence of fabellae was 27%, a figure near the high end of the previously reported range. To our knowledge, the geometric relationship of the fabella to the CPN has not previously been reported. Using measurements taken during dissection of fabellae, the zone of potential locations of the fabella overlapped 26.0% of the length of the CPN across the lateral head of the gastroenemius. © 1993 Wiley-Liss, Inc.