带血管神经蒂股薄肌瓣重建尿道括约肌的应用解剖

目的为带血管神经蒂股薄肌瓣转位重建尿道括约肌术提供解剖学基础。方法在35例成人下肢标本上,对股薄肌的形态、主要血管、神经的来源,血管神经蒂的长度、入肌部位等进行解剖观测。结果股薄肌全长(42.0±0.6)cm,肌腹长(31.0±3.8)cm;肌腱长(10.9±0.9)cm;股薄肌的血供主要来源于股深动脉的股薄肌支,该分支起始处外径(2.1±0.6)mm,血管蒂长(9.2±0.9)cm,入肌部位在股薄肌中、上1/3交界处前缘的深面;股薄肌的神经支配,均恒定地来自闭孔神经前支,该神经在闭膜管处,横径为(1.7±0.4)mm;厚(0.5±0.2)mm,从闭膜管至入肌点处长(10.4±1.4)cm。结论带血管神经蒂股薄肌瓣转位重建尿道括约肌术,经尸体摹拟实验,证明具有可行性。     

以胫前返血管为蒂腓骨上段移植的应用解剖

目的:为胫前返血管蒂腓骨瓣的设计提供解剖学基础。方法:30侧经动脉红色乳胶灌注的成人下肢标本,解剖观测胫前返动脉的起始、走行、分支及分布。结果:胫前返动脉始于胫前动脉,起始点距腓骨头尖下(4.5±0.7)cm(3.0～6.0cm),动脉主干长(0.5±0.2)cm(0.2～1.2cm),外径(2.0±0.4)mm(1.3～3.0mm),伴行静脉2条,外径为(2.1±0.5)mm(1.5～3.0mm)和(2.6±0.4)mm(1.7～3.2mm)。胫前返动脉腓骨头支1～2支,外径(1.7±1.3)mm(0.6～2.1mm),分布于腓骨头的前内侧面骨膜,并与其它来源的腓骨上段骨膜支构成动脉网。腓骨头支起始点至胫前返动脉起始点长度为(1.0±0.4)cm(0.3～1.8cm),其中长度≥1.0cm者占46.7%。腓骨头支起始点以远1.5cm处的胫前返动脉外径为(1.4±0.5)mm(0.8～2.1mm)。结论:胫前返血管蒂腓骨瓣的的设计具有可行性,为临床带血管腓骨上段移植提供一种新的可供选择的血管蒂。     

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     

带腓肠外侧皮神经及其营养血管筋膜皮瓣的应用解剖

<正> 为带腓肠外侧皮神经及其营养血管筋膜皮瓣的临床应用提供解剖学基础.在32侧成人下肢标本上,对腓肠外侧皮神经及其营养血管进行解剖观测.结果:腓肠外侧皮神经在腓骨头平面上方(7.l±2.4)cm处起于腓总神经,横径为(2.6±1.0)mm,沿腘窝及小腿后外侧面下行,腓骨头平面的横径为(3.0±0.9)mm,发出1-3个终支,分布于小腿后外侧上半或上2/3的皮肤.其营养动脉主要为:①腓肠外侧皮动脉;起自腘动脉外侧壁,在排骨头平面上方(5.0±1.5)cm处浅出,外径为(0.9±0.3)mm,穿出前长度为(3.11.2)cm,伴腓肠外侧皮神经及其主要分支下行;②肌间隔筋膜皮支:起自胫后动脉(占54.5%)和腓动脉(占45.5%),向后外行,自小腿三头肌与腓骨长、短肌之间的肌间隔穿出,穿出点分别在腓骨头平面下方(9.2±3.8)cm和(15.8±3.8)cm,外径为(0.7±0.3)mm和(0.9±0.4)mm,穿出前长度分别为(3.6±1.1)cm和(3.6±1.4)cm.该营养动脉除在腓肠外侧皮神经主干及其分支旁或其内呈相互吻合,形成纵行的动脉丛(网)外,沿途还发出分支至周围的筋膜皮肤,并借吻合支     

肩胛上血管肩峰支肩胛冈骨瓣移位术的应用解剖

目的:为锁骨肩峰端骨不连修复提供新的手术方法。方法:在40侧成人尸体标本上,解剖观测肩胛上血管肩峰支的走行、分支及分布;1 侧标本上摹拟手术设计。结果:肩峰支自肩胛上动脉发出后,向外走行于斜方肌、冈上肌之间,穿斜方肌在肩峰处的附着点达肩峰,并与胸肩峰动脉的肩峰支吻合构成肩峰动脉网。其长度为4.6±1.1cm,外径1.7±0.4mm。其主要分支肩胛冈支外径0.8±0.1mm,长度2.0±0.5cm。结论:可以肩峰支为蒂设计切取肩胛冈骨瓣移位修复锁骨肩峰端骨不连。     

肩胛上血管肩峰支肩胛冈骨瓣移位术的应用解剖

目的为锁骨肩峰端骨不连修复提供新的手术方法.方法在40侧成人尸体标本上,解剖观测肩胛上血管肩峰支的走行、分支及分布;1侧标本上摹拟手术设计.结果肩峰支自肩胛上动脉发出后,向外走行于斜方肌、冈上肌之间,穿斜方肌在肩峰处的附着点达肩峰,并与胸肩峰动脉的肩峰支吻合构成肩峰动脉网.其长度为4.6±1.1cm,外径1.7±0.4mm.其主要分支肩胛冈支外径0.8±0.1mm,长度2.0±0.5cm.结论可以肩峰支为蒂设计切取肩胛冈骨瓣移位修复锁骨肩峰端骨不连.     

同种异体带血供肱骨移植的解剖学研究

目的为吻合血管同种异体肱骨移植提供解剖学依据。方法在40侧经动脉灌注红色乳胶的成人上肢标本上,着重观测肱骨上端及肱骨干滋养血管和骨膜血管的来源、分布、长度和外径;50根干燥成人肱骨,观察肱骨上端及肱骨干的滋养孔。结果肱骨上端外科颈周围平均有(7.7±2.0)个(4～12个)滋养孔,滋养支来自旋肱前动脉和旋肱后动脉。肱骨干滋养孔1～3个,主要位于肱骨中段前内侧面,距内上踝(11.7±2.2)cm(6.5～17.0cm)。滋养动脉主要来自肱动脉,长(2.6±0.7)cm(1.5～5.0cm),外径(1.3±0.6)mm(0.8～2.2mm)。结论选用旋肱前血管为蒂,可行肱骨上段移植,选用肱血管和肱深血管为蒂,可作肱骨中段移植。     

双轴点掌背皮动脉轴行皮瓣的应用解剖

目的 :报道手背一种新型皮动脉岛状皮瓣设计的解剖学基础。方法 :对 2 0侧新鲜成人标本 ,在 5倍显微镜下观测掌背血管、肌腱、神经的解剖特点和皮肤的血供。结果 :手掌背皮下组织内存在掌背动脉相平行的皮动脉。第 1掌背动脉出现率为 95 % ,起点外径 ( 0 .8± 0 .1)mm ,长度 ( 7.8± 1.1)cm ,末端外径 ( 0 .4± 0 .2 )mm。第 2掌背动脉出现率为 10 0 % ,起点外径 ( 0 .6± 0 .1)mm ,长度 ( 6.5± 0 .8)cm ,末端外径 ( 0 .4± 0 .1)mm。第 3掌背动脉出现率为 10 0 % ,起点外径 ( 0 .5± 0 .1)mm ,长度 ( 6.5± 0 .7)cm ,末端外径 ( 0 .3± 0 .1)mm。第 4掌背动脉出现率为 90 % ,起点外径 ( 0 .4± 0 .1)mm ,长度 ( 5 .5± 0 .9)cm ,末端外径 ( 0 .3± 0 .1)mm。结论 :掌背皮动脉走行、分支较为恒定 ,可以其为蒂 ,设计双轴点的顺行或逆行岛状皮瓣 ,用于腕、手及手指的软组织缺损的修复。     

以踝管区动脉穿支为蒂隐神经-大隐静脉营养血管皮瓣的显微解剖

目的:为踝管区动脉穿支隐神经-大隐静脉营养血管皮瓣设计提供解剖学依据。方法:30侧经动脉内灌注红色乳胶成人下肢标本,解剖观测踝管区动脉穿支、胫后动脉肌间隙支及邻近动脉吻合。结果:踝管区近侧筋膜穿支2支,外径(0.8±0.3)mm(0.4~1.3mm),中侧筋膜穿支0~2支,外径(0.8±0.2)mm(0.4~1.2mm),远侧筋膜穿支2~3支,外径(1.0±0.4)mm(0.5~2.0mm),共同构成踝管区浅深筋膜及皮肤营养血管。在小腿内侧下1/3段,胫后动脉肌间隙支2~3支,平均外径(1.1±0.3)mm(0.5~2.5mm),骨皮穿支1~2支,平均外径(1.0±0.3)mm(0.4~2.0mm)。上述穿支形成隐神经、大隐静脉营养血管及深、浅筋膜血管网。结论:踝管区筋膜穿支支数较多,与胫后动脉肌间隙支吻合丰富,以踝管区筋膜穿支为蒂的隐神经-大隐静脉营养血管皮瓣,旋转点在内踝平面,可用于转位修复足前部的软组织缺损。     

桡神经肱三头肌支转位修复腋神经的应用解剖

目的:为桡神经肱三头肌支转位修复腋神经提供解剖学基础.方法:观测50侧上肢标本桡神经肱三头肌支的起点、横径、无损伤分离长度,测量腋神经前、后支起点、横径;在2侧新鲜上肢标本上切取上述肌支,乙酰胆碱酯酶(AchE)染色组织学观察神经束性质,体视显微镜下神经纤维计数.结果:肱三头肌每个头均有桡神经发出的的2～4支肌支,桡神经肱三头肌各肌支与腋神经前支在横径、纤维数上相近,长头及内、外侧头肌支可分离长度大于其起点与腋神经起点间的距离.结论:腋神经损伤后,桡神经肱三头肌支可转位修复腋神经重建肩外展功能.     

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.     

腋窝入路桡神经肱三头肌支转位移植修复腋神经的应用解剖

背景：上臂后上切口入路肱三头肌肌支转位移植修复腋神经牵拉三角肌时易损伤腋神经后支及锁骨上臂丛,探查和联合其他神经转位时需变更体位。 目的：分析腋窝入路桡神经肱三头肌支转位移植修复腋神经的可行性。 方法：取常规甲醛固定成人上肢标本10具20侧,于标本平卧,上肢外展外旋位,腋窝入路,对腋窝处神经血管进行显微解剖。测量腋神经起始处至分支处距离及其分支起始处的横径,肱三头肌各肌支起始处横径,各肌支由入肌点向近端进行无损伤分离长度。 结果与结论：腋神经肩胛下肌下缘分成前后两支,前支横径平均为2.5(1.6~3.4) mm。桡神经肱三头肌长头支,起点处横径为2.2(1.4-2.8) mm。桡神经与腋神经距离平均为18.2(10.2~30.0) mm。腋神经前支与桡神经肱三头肌支横径相似,距离短。表明腋窝入路可暴露和辨别腋神经前后分支,桡神经肱三头肌支在背阔肌腱表面水平靠近腋神经,可选择任一肌支转位移植修复腋神经。      

Topographical anatomy of the radial nerve and its muscular branches related to surface landmarks

Understanding of the anatomy of the radial nerve and its branches is vital to the treatment of humeral fracture or the restoration of upper extremity function. In this study, we dissected 40 upper extremities from adult cadavers to locate the course of the radial nerve and the origins and insertions of the branches of the radial nerve using surface landmarks. The radial nerve reached and left the radial groove and pierced the lateral intermuscular septum, at the levels of 46.7, 60.5, and 66.8% from the acromion to the transepicondylar line, respectively. Branches to the long head of the triceps brachii originated in the axilla, and branches to the medial and lateral heads originated in the axilla or in the arm. The muscular attachments to the long, medial, and lateral heads were on average 34.0 mm proximal, 16.4 mm distal, and 19.3 mm proximal to the level of inferior end of the deltoid muscle, respectively. The radial nerve innervated 65.0% of the brachialis muscles. Branches to the brachioradialis and those to the extensor carpi radialis longus arose from the radial nerve above the transepicondylar line. Branches to the extensor carpi radialis brevis usually arose from the deep branch of radial nerve (67.5%); however, in some cases, branches to the extensor carpi radialis brevis arose from either the radial nerve (20.0%) or the superficial branch of the radial nerve (12.5%). Using these data, the course of the radial nerve can be estimated by observing the surface of the arm. Clin. Anat. 26:862–869, 2013. © 2012 Wiley Periodicals, Inc.     

Surgical anatomy of the radial nerve branches to triceps muscle

The objectives of the study are to demonstrate the innervation patterns of the triceps muscles and the most suitable branch of the radial nerve for nerve transfer to restore the motor function of the deltoid muscle in patients with complete C5–C6 root injury. Seventy‐nine arms (40 left arms and 39 right arms) from 46 embalmed cadavers (24 male and 22 female) were included in the study. The nerves to the triceps were dissected from the triceps muscles (long head, lateral head, and medial head). The lengths of the branches were measured from the main trunk. The distance from the inferior margin of the teres major muscle to the origin of the nerve to the long head, lateral head, and medial head of the triceps were recorded as well. The first branch was the nerve to the long head of the triceps in 79 arms (100%). The second branch was the nerve to the upper medial head in 30 arms (38%), nerve to the medial head in 8 arms (10.1%), nerve to the upper lateral head in 35 arms (44.3%) and nerve to the lateral head in 6 arms (7.6%). The patterns of branches to the triceps were classified according to our dissections. The nerve to the long head of the triceps was constant as the first branch of the nerve to the triceps branch of the radial nerve in the vicinity of the inferior margin of the teres major muscle. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.     

Axillopectoral muscle (Langer's muscle)

In a routine dissection of the axillary fossa, a muscle originating from the coracoid process of the scapula and extending to the long head of triceps brachii muscle was observed. The mentioned muscle was adhering to both the triceps brachii muscle and the tendinous part of the latissimus dorsi muscle. This anatomical variation is referred to as axillary arch (Langer's muscle or axillopectoral muscle). The muscle mass was measured 9.6 cm in length and 1.4 cm in width. The accessory muscle can be a reason of an axillary mass and can exert pressure on the neighboring neurovascular bundle or lymph routes; thus, exposing a wide range of symptoms. Therefore, variations of this area should be kept in mind in surgical interventions.     

枕小和耳大神经移植修复面神经缺损的应用解剖

目的为枕小和耳大神经移植修复面神经缺损提供形态学基础。方法在32侧成人标本上,观测颈丛皮神经的行程、长度、横径和血供情况。结果枕小和耳大神经的长度分别为（7．7±0．8）cm和（7．9±0．9）cm;横径分别为（1．6±0．4）mm和（2．2±0．4）mm。枕小和耳大神经的血供主要来源于颈升动脉神经支、枕动脉的胸锁乳突肌皮支和耳后动脉皮支。结论枕小和耳大神经可作为面神经移植的一个合适而易得的理想供体,行自体神经游离移植或吻合血管神经移植用以修复各种原因所致的面神经缺损。     

骨间后神经受压的解剖学基础

目的阐明骨间后神经(PIN)卡压的原因及其手术治疗提供解剖基础。方法30侧尸体上肢标本,将PIN分为3段(即桡管段、旋后肌管段和旋后肌管后段)观察其肌支的分支情况;用卡尺对桡管(RT)、旋后肌管(ST)和桡侧腕短伸肌腱弓(AECRM)的形态和大小进行了观测,并对ST入口和出口的体表投影定位。结果ST入口和出口的宽度分别为(14.1±2.1)mm和(6.2±1.7)mm,长度为(35.0±6.9)mm。PIN从桡骨头至旋后肌腱弓(AF)和PIN从旋后肌穿出处的长度分别为(19.3±4.4)mm和(53.4±5.2)mm。AF的53.3%由肌性加腱性组织构成,23.3%由腱性组织构成,23.3%由肌组织构成。70%旋后肌远侧缘由腱性组织构成,所有AECRM均是腱性。桡骨背侧桡骨头下方1示指宽和3示指宽分别为ST的入口和出口的体表投影。结论本文提供的RT、ST和AECRM详细形态资料,对于PIN卡压的诊断和手术治疗具有指导意义。     

Bilateral double axillary artery: embryological basis and clinical implications

An unusual bilateral variation in the arterial pattern of the axilla was observed in an embalmed cadaver. Each axilla contained two axillary arteries of similar origins but different patterns of branching and fate. The first part of each axillary artery was a single vessel as is the norm. It gave off a supreme thoracic artery and then bifurcated into two medium-sized arteries hence referred to as regular and variant. The variant artery ran in an antero-medial course, partly covered by the one axillary vein. The regular artery gave off the thoracoacromial and two posterior branches from its second part, the anterior and posterior humeral circumflex arteries from its third part, and then continued as the brachial artery with all the usual branches except the profunda brachii on the right side. The variant gave off five arteries from the second part, a thoracoacromial artery, two separate long thoracic arteries each with a branch that ran along the intercostobrachial nerve to the arm, and two posterior branches. In the third part of the variant, the subscapular artery arose with its usual branches plus a common origin for two additional humeral circumflex arteries. The variant terminated as the profunda brachii artery to the right side while on the left side it terminated in muscular branches to the triceps. Hence, the arterial blood supply to the upper limb, and the axillary region in particular, was shared on both sides by two major arteries instead of one. These two arteries emanated from the first part of the axillary artery and may represent persisting branches of the capillary plexus of the developing limb buds. The findings have an embryological basis and clinical relevance considering the frequency of procedures in this region.