带血管掌骨片移位重建舟骨血运的外科解剖

研究了30例成人掌骨背侧的血供,第一掌骨背侧恒定地由拇拍背侧动脉供给,可以设计以拇指背侧血管为蒂的第一掌骨片移位,用以治疗舟骨骨折后缺血性坏死。     

微CT构建人手舟骨骨内血管高精度三维模型

目的 通过微CT (micro CT)扫描重建获得手舟骨内血管高精度模型,为临床提供解剖学参考。方法 选取3个新鲜上肢,从肱动脉插管并灌注铅丹造影剂,灌注结束24 h后解剖手舟骨。用micro CT扫描,构建手舟骨血管三维模型以观察手舟骨的骨内及骨外血管分布。结果 手舟骨表面存在一个连续的“Ⅴ”型血管区,自掌侧桡腕关节远端的韧带附着区到达手舟骨腰部桡侧,进一步折返沿背侧嵴向近端尺侧延伸。手舟骨桡侧腰部的“Ⅴ”型折返点和背侧血管较为密集。手舟骨桡侧远端结节内的骨内血管较为丰富,有3～5支骨内主干血管,来自于桡侧腰部和结节周围的骨外血管。而手舟骨近端尺侧的骨内血管只有1～2支主干血管,且行程较长。舟月骨间韧带内的血管没有发出骨内分支。结论 手舟骨表面存在一个连续的“Ⅴ”型的血管区。手舟骨桡侧腰部的“Ⅴ”型折返点和背侧血管较为密集,其骨内分支是手舟骨的主要供血来源。     

手舟骨骨内动脉的数字解剖学研究及其临床意义

目的　利用Micro-CT对手舟骨骨内动脉进行可视化数字模型构建并分析其临床意义。 方法 对12例离体人体前臂标本进行动脉血管灌注，Micro-CT扫描并运用Mimics20.0软件对血管进行三维重建，并分析重建数据，整理舟骨的滋养动脉分布。 结果　（1）重建出含骨内血管的腕舟骨数字化可视模型，可自由测量舟骨和血管的解剖数据，并清晰显示滋养动脉在骨内的分布及出入点；（2）右手复合组和左手复合组中滋养血管的数目分别为（4.670±1.366）支、（3.830±0.753）支，掌侧滋养血管分别为（1.670±0.516）支、（1.330±0.516）支，背侧滋养血管分别为（3.000±1.095）支、（2.500±0.548）支。 结论　离体腕部标本动脉灌注后骨内血管三维重建能清晰显示手舟骨骨内滋养动脉的来源及空间分布，为舟骨骨折的临床研究提供了形态学基础。     

手舟骨的形态、血供及临床意义

在100侧手舟骨,30侧手标本和4个新鲜手血管透明标本上,观察了手舟骨的形态,表面投影和血供规律。手舟骨有84%是中部细小型,故多发生中部骨折。舟骨滋养孔83.9%集中手舟骨背外侧面,采用背侧手术入路时,尽可能减少对腕背侧韧带的剥离或横断,以保护部份血供来源。舟骨内固定进针时,可采用手背伸30°,内收10～15°,按舟骨结节至桡骨背侧结节下缘这个表面摄影穿入,方向以与水平线呈20～25°,与前臂冠状平面呈30～45°为宜。     

带血管桡骨茎突瓣移位治疗手舟骨骨折的应用解剖

在50侧干燥桡骨、38侧经红乳胶动脉灌注的手标本和4侧血管铸型标本上,观察了桡骨茎突的滋养孔和血供来原.桡骨茎突背侧距茎突尖1.5cm范围内平均有滋养孔10.3个。桡骨茎突血供主要来自桡动脉茎突返支,由桡动脉在桡骨茎突平面至其下方1.2cm之间发出,平均长1.2cm.外径0.4mm.设计了以桡动脉茎突返支为蒂的桡骨茎突骨瓣转位治疗陈旧性手舟骨骨折术式,并对手术设计和解剖学要点进行了讨论.     

带血管蒂第二,三掌骨瓣转位修复手舟骨骨折的应用解剖

观察40侧成人手标本,第一掌背动脉是第二掌骨背桡侧的主要血供来源,可分3种类型.可以第二掌背动脉为蒂,第二、三掌骨近端和远端骨瓣转位.修复陈旧性手舟骨骨折。文中讨论了与该术式有关的应用解剖学要点.     

足舟骨的测量

足舟骨的研究文献国内报道不多见,为积累国人资料.本文对足舟骨进行了调查.1 材料和方法 所用材料为成都地区收集的供研究用的成年足舟骨160例(男92例;左侧44例.侧48例.女68例,左侧33例,右侧35例).左右侧配套.方法依据吴汝康、吴新智编著《人体骨骼测量方法》进行     

经舟骨月骨周围脱位的诊断和治疗

目的 探讨经舟骨月骨周围脱位的诊断和治疗。方法 回顾性分析17例经舟骨月骨周围脱位病例，背侧型13例，掌侧型4例；新鲜损伤组10例中8例行撬拨复位成功，仅2例因舟骨对位不良接受手术治疗；陈旧性组7例中均接受手术，4例行开放复位内固定，3例行近排腕骨切除术。结果 采用Cooney评价标准，优11例，良3例，可1例，差2例，优良率82．35％。结论 经舟骨月骨周围脱位的早期治疗简单且疗效较好，而一旦误诊，则多数需手术治疗，且残留不同程度的功能障碍。提高对本病损伤机制、腕部体征和影像学特点的认识和了解，减少误诊。是提高本病预后的关键因素之一。     

第1跖趾关节及趾趾间关节的血供特点及其临床意义

目的：弄清第１跖趾关节和趾趾间关节的血供。方法：正常动脉灌注红色乳胶成人足２４只,观测第１跖趾关节和趾趾间关节的结构,各关节血管及神经的分布情况。结果：第１跖趾关节的动脉关节支来源于第１跖背动脉、第１跖底动脉以及它们的分支趾趾背动脉、趾底动脉和横动脉。它有背胫侧、背腓侧、跖胫侧、跖腓侧、关节前和关节后６部分关节支。趾趾间关节的动脉关节支来源于趾趾背动脉、趾底动脉和横动脉。它有背胫侧、背腓侧、跖胫侧、跖腓侧和关节后５部分关节支。结论：第１跖趾关节和趾趾间关节的血供丰富,但跖侧多于背侧,腓侧多于胫侧,故这些部位手术时,切口尽可能在背胫侧,以减少对关节血供的影响。     

足背和足底的动脉分布

作者解剖了100个足标本,观察了足背和足底动脉的分布。足背动脉的外径平均2.47mm,其中外径小于1.5mm的有8％。典型足背动脉缺乏的为4％。足背动脉起点异常的5％。此外,作者还观察了足背动脉的行程,动脉主干与(足母)长伸肌腱、以及腓深神经的位置关系。足背动脉的分支中,内、外踝前动脉均以起在踝关节水平者较多见。跗内侧动脉较细,数目及大小均多变化,通常有1～2个较显著的分支。跗外侧动脉较粗,位置亦较恒定,其外径平均1.56mm,以位于距骨头颈连接水平者为最多见。低位弓状动脉出现35％,其中发出第二至四跖背动脉的典型弓状动脉仅见17％。跖背动脉的起始变化最多,基本上可归纳为背侧、跖侧、跖背侧起始三类。第一跖背动脉起自背侧及跖侧者数字相近。第二至四跖背动脉自跖侧起始者稍多于背侧,但同时起自跖背侧者并不少见。所谓跗骨窦动脉实际上应包括来自外踝前动脉和跗外侧动脉的二个分支,二支常同时存在。足底动脉主干的位置、行径比较恒定。胫后动脉的外径平均2.6mm,其分歧部位恒位于分裂韧带下缘附近。足底外侧动脉大于足底内侧动脉的有82％。在足底动脉弓的形成中,足底深支常居优势(71％)。跖底动脉均以起自足底动脉弓者居多数,相邻跖底动脉可共干起始,起自足底内侧动脉或足底外侧动脉者为数较少。第一至三跖底动脉的外径很少变化,但第四跖底动脉的行径则有变异。最后,作者重点讨论了有关足背动脉研究中存在的几个问题以及足底浅动脉弓在人类的残遗。     

吻合足底内侧动脉浅支足底内侧皮瓣移植修复手部缺损的应用解剖

目的为以足底内侧动脉浅支及其皮支为蒂游离足底内侧皮瓣修复手部缺损提供解剖学基础。方法在20侧成人下肢标本、6只灌注红色乳胶成人新鲜足标本及10侧下肢动脉铸型标本上解剖观测了足底内侧动脉浅支足底内侧皮支起始部位、走行、长度、外径、分支分布及吻合。结果足底内侧动脉浅支足底内侧皮支于舟骨粗隆后(1.5±0.4)cm下方发出,向前下斜行至足底内侧皮肤;该皮支长(2.8±0.2)cm,外径(0.8±0.2)mm。结论①足底内侧皮瓣可以是足底内侧动脉浅支足底内侧皮支或足底内侧动脉深支足底皮穿支为供血。②足底内侧皮瓣游离移植适用于手掌及手指腹侧创面修复的特殊需要。     

跖骨的动脉分布

通过动脉灌注研究了９０侧不同年龄（婴儿至８７岁）尸体跖骨的血液供应。分布于跖骨的动脉来自滋养动脉、骨膜动脉、骺－干骺动脉和假骺动脉。滋养动脉的近、远侧支供应皮质的内２／３￣３／４；骨膜动脉发出少量小支进入骨皮质，供应皮质的外１／３￣１／４；骺－干骺动脉呈轮辐状发自续于跖骨干的骨膜动脉浅丛，供应第１跖骨底和第２￣５跖骨头；假骺动脉从骺－干骺动脉发出后，穿过非关节面区，供应第２￣５跖骨底和第１跖骨头。     

Arterial anatomy of the hallucal sesamoids

The aim of this study was to analyze the arterial supply of the sesamoid bones of the hallux. Twenty‐two feet from adult cadavers were injected with epoxide resin or an acrylic polymer in methyl methacrylate (Acrifix®) and subsequently processed by two slice plastination methods and the enzyme maceration technique. Afterwards, the arterial supply of the sesamoid bones was studied. The first plantar metatarsal artery provided a medial branch to the medial sesamoid bone. The main branch of the first plantar metatarsal artery continued its course distally along the lateral side of the lateral sesamoid and supplied it. The supplying arteries penetrated the sesamoid bones on the proximal, plantar, and distal sides. The analysis and cataloging of the microvascular anatomy of the sesamoids revealed the first plantar metatarsal artery as the main arterial source to the medial and lateral sesamoid bones. In addition, the first plantar metatarsal artery ran along the lateral plantar side of the lateral sesamoid bone, suggesting that this artery is at increased risk during soft‐tissue procedures such as hallux valgus surgery. Clin. Anat. 22:755–760, 2009. © 2009 Wiley‐Liss, Inc.     

The developmental anatomy of the equine navicular bursa and associated structures

Summary The navicular bone, navicular bursa and their associated structures were collected from 20 horses ranging in age from 80 days gestation to 2 years post-gestation. The right front foot of every horse was sampled for light microscopy. The development of the navicular bursa and associated structures were studied.Study of the developmental anatomy of the equine navicular bursa established that the bursa is a distinct entity in both the fetus and the adult horse.Development of the bursal cavity in the fetus was found to be complete by 120 days of gestation. Synovial membrane of the navicular bursa was first evident at 100 days of fetal age. With increasing fetal maturation there was a concurrent development in the synovial membrane consisting of increased cellularity, vascularity and villi formation.Nerve fibers or nerve endings were not observed within the synovial membrane of the navicular bursa. However, nerve bundles were often observed within the associated connective tissue, bursal capsule and distal navicular ligament. Pacinian corpuscles were observed in the 200-day fetus in close proximity to the navicular bursa.The development of a fibrous bursal capsule was first evident at 160 days fetal age, thereafter increasing in both thickness and density.Ligaments of the navicular bone were found to develop early in fetal life. At 100 days the collateral sesamoidean ligaments were well developed; however earliest evidence of formation of the distal navicular ligament was at 120 days.In both the fetus and the adult the proximal blood supply to the navicular bone was found to course dorsally in close proximity to the collateral sesamoidean ligament to enter the proximal border of the navicular bone.Concurrent with weight bearing there was a dorsal palmar orientation of the bone trabeculae of the navicular bone. In the young postgestational horses a progressive roughening or fraying of the palmar surface of the navicular bone and the apposing surface of the deep digital flexor tendon was evident.     

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。     

跟骨血供及其临床意义

通过动脉灌注,对56侧不同年龄(新生儿至67岁)尸体跟骨的血液供应进行了研究。跟骨的动脉分散发自胫后动脉、足底内、外侧动脉、腓动脉、跗外侧动脉、跗骨管动脉和跗骨窦动脉,围绕跟骨组成致密的骨膜动脉网。此网发辐射状动脉至骨内,籍吻合支互连成丛。随骺(软骨)板闭合,于骺动脉与骺动脉之间建立广泛吻合。对跟骨血管分布的临床意义进行了讨论。     

Morphometric study of the equine navicular bone: variations with breeds and types of horse and influence of exercise

Navicular bones from the 4 limbs of 95 horses, classified in 9 categories, were studied. The anatomical bases were established for the morphometry of the navicular bone and its variations according to the category of horse, after corrections were made for front or rear limb, sex, weight, size and age. In ponies, navicular bone measurements were smallest for light ponies and regularly increased with body size, but in horses, navicular bone dimensions were smallest for the athletic halfbred, intermediate for draft horse, thoroughbreds and sedentary halfbreds and largest for heavy halfbreds. The athletic halfbred thus showed reduced bone dimensions when compared with other horse types. Navicular bones from 61 horses were studied histomorphometrically. Light horses and ponies possessed larger amounts of cancellous bone and less cortical bone. Draft horses and heavy ponies showed marked thickening of cortical bone with minimum intracortical porosity, and a decrease in marrow spaces associated with more trabecular bone. Two distinct zones were observed for the flexor surface cortex: an external zone composed mainly of poorly remodelled lamellar bone, disposed in a distoproximal oblique direction, and an internal zone composed mainly of secondary bone, with a lateromedial direction for haversian canals. Flexor cortex external zone tended to be smaller for heavy ponies than for the light ponies. It was the opposite for horses, with the largest amount of external zone registered for draft horses. In athletic horses, we observed an increase in the amount of cortical bone at the expense of cancellous bone which could be the result of reduced resorption and increased formation at the corticoendosteal junction. Cancellous bone was reduced for the athletic horses but the number of trabeculae and their specific surfaces were larger. Increased bone formation and reduced resorption could also account for these differences.     

展肌上缘动脉弓的分型及其临床意义

目的　对 展肌上缘动脉弓的形成进行分型，为以　展肌上缘动脉弓为蒂逆行足底内侧皮瓣的临床应用提供解剖学基础。 方法 在81例足动脉铸型标本和2只动脉灌注红色乳胶成人新鲜下肢标本上观察　展肌上缘动脉弓的形成、走形与分布。 结果　根据　展肌上缘动脉弓的形成将其分为3型：Ⅰ型.内踝前动脉与跗内侧动脉型：主要由内踝前动脉、跗内侧动脉及其分支形成，占22.9%（19例）。Ⅱ型.足底内侧动脉浅支型：主要由足底内侧动脉浅支及其分支形成，占3.6%（3例）。Ⅲ型.混合型：由足底内侧动脉浅支与内踝前动脉、跗内侧动脉及其分支相互吻合形成。根据吻合形式的不同，又将其分为两个亚型，Ⅲ1型.直接吻合型：内踝前动脉、跗内侧动脉发出后直接与足底内侧动脉浅支及其分支吻合形成，占48.2%（40例）；Ⅲ2型.间接吻合型：内踝前动脉、跗内侧动脉发出后与足底内侧动脉浅支及其分支相互吻合成环形，占24.1%（20例）。 结论　根据　展肌上缘动脉弓形成的不同分为内踝前动脉与跗内侧动脉型、足底内侧动脉浅支型和混合型。其中混合型又分为直接吻合型和间接吻合型两种亚型。     

The microvascular anatomy of the metatarsal bones: a plastination study

Purpose  The purpose of this study was to categorize and systematize the arterial supply of the metatarsal bones and furthermore the observation of arterial lesions after frequently performed forefoot surgeries. Materials and methods  Twenty-two cadaver feet were analyzed by two plastination methods and the enzyme maceration method. Five forefoot surgeries were performed after arterial injections. Results  The bases of the metatarsal bones were primarily supplied by dorsal and plantar arteries. The arterial supply of the metatarsal diaphysis was given by a frequently observed nutrient artery. The first plantar metatarsal artery was the main supply of the first metatarsal head. The plantar and dorsal metatarsal arteries supplied the lesser metatarsals heads. The forefoot surgeries revealed lesions of arteries in all cases. Conclusions  The plastination methods were excellent methods to analyze the arterial supply. In addition arterial damage after forefoot surgeries could be analyzed with these methods.     

Anatomic study of the deep plantar arch

A thorough knowledge of the topography and relations of the plantar arteries is necessary for further advances in arterial reconstruction in the foot. Such reconstruction often avoids amputation in cases of arterial trauma in industrial and automobile accidents, as well as in patients with diabetes and severe ischemia of the lower limbs. Although several studies have addressed the anatomy of the arteries of the foot, there is a shortage of recent studies on surgical vascular anatomy. The deep plantar arch was studied in 50 adult cadaveric feet. It was present in all feet and formed from the anastomosis between the deep plantar artery and the deep branch of the lateral plantar artery. The deep plantar artery was predominant in 48% of the specimens (Type I arches) and the deep branch of the lateral plantar artery in 38% (Type II) with the contribution of each being approximately equal in 14% (Type III). The location of the deep plantar arch can be estimated. The distance between the deep plantar arch and each interdigital commissure was relatively consistent between the subjects, averaging 29% of total foot length. The deep plantar arch was located in the middle third of the foot in all specimens, being in the middle II part of this third in 62%. The mean external diameter of the deep branch of lateral plantar artery was 1.7 mm +/- 0.4 mm. The mean external diameter of the deep plantar artery was also 1.7 mm +/- 0.4 mm. We observed a complete superficial plantar arch in only one specimen (2%). Our findings should assist vascular surgeons in estimating the location of the deep plantar arch from the patient's foot length and in providing other data.