跟外侧动脉的解剖学研究

目的 解剖观察跟骨外侧皮肤的血供,了解跟外侧动脉的影响.方法 人体下肢常规防腐动脉内红色乳胶灌注标本解剖观察跟骨外侧动脉的来源、走行、分布和吻合.结果 跟外侧动脉在外踝尖上方12～34mm处来自腓动脉发出,向后下方迂曲走形,在跟骨结节水平距跟腱前缘距离6～15mm,转而向下方,与足底垂直走形,在足后跟转而向前,通向第五跖骨基底.跟外侧动脉在外踝尖后下方和下方沿跟骨外侧壁迂曲行进,发出分支支配跟外侧皮肤血运,到第V跖骨基底附近与跗外侧动脉形成血管网.结论 跟外侧动脉在跟骨外侧位置恒定,主干清晰,是支配跟骨外侧皮肤血运的主要动脉.     

以跗外侧动脉为蒂骰骨瓣转位修复距骨颈骨折的应用解剖

在30侧下肢标本上解剖观测了骰骨背侧面血管的来源、走行、分支和分布。骰骨背侧面的动脉主要来自跗外侧动脉。该动脉穿趾短伸肌深面,紧贴骰骨背侧面中份行走。行经骨面时,发出5～12支管径在0.3～1.0mm 至骰骨。以跗外侧动脉为蒂的骰骨瓣大小约为2×1cm。经临床应用证明,本骨瓣是修复距骨颈骨折距骨体缺血性坏死简易可行的一种新术式。     

跟外侧动脉穿支皮瓣的应用解剖

目的　探讨跟腱区及跟部皮肤软组织的血供解剖学,为跟外侧动脉穿支皮瓣的临床应用提供解剖学基础。 方法　16侧经红色乳胶灌注的成人下肢标本,解剖观察跟外侧动脉“垂直段”及其穿支血管的位置、口径、数目及分布规律。 结果　位于小腿后骨筋膜鞘深部的腓动脉于外踝尖上(6.6±1.1) cm ( 5.5~9.4 cm) 发出腓动脉前穿支和跟外侧动脉,跟外侧动脉下行穿出分隔小腿后骨筋膜鞘浅、深部之小腿后筋膜隔到达外踝后间隙,于腓骨肌腱与跟腱之间移行,继续绕外踝向前下方分布。小腿下段腓动脉、跟外侧动脉穿支数为(3.6±0.7)支,口径为（0.9±0.29） mm,营养跟腱区及跟部皮肤软组织。 结论　研究结果显示跟腱区及跟部皮肤软组织的血供主要来源于腓动脉、跟外侧动脉,为跟外侧动脉的命名、临床应用以及小腿中下段皮瓣的设计和跟部手术提供解剖学基础。     

以骨间返血管为蒂尺骨上端骨膜骨瓣的应用解剖

解剖观察了40侧上肢标本和60侧干燥尺骨标本。尺骨上端由骨间返动脉和尺侧后返动脉分支分布.其中骨间返动脉恒定走行于尺、桡骨上端之间,发丰富的骨膜支至尺骨上端桡侧,动脉长5.7cm,外径1.1mm,可以此血管为蒂形成尺骨上端骨膜骨瓣移位修复邻近的骨缺损、骨不连。     

旋股外侧血管横支大转子骨瓣修复股骨中上段的解剖及应用

目的：为股骨干骨缺损、骨折骨不连修复提供新的手术方法，方法：在４０侧标本上对旋股外侧动脉横支进行解剖学观察，设计了以该血管为蒂大转子骨瓣转位修复股骨干中、上段及股骨头颈部骨折、骨缺损。结果：该动脉外径２．５ｍｍ，长度５．１ｃｍ，在股外侧肌深面和外缘发出２～４支外径在０．４～１．１ｍｍ的骨膜支到大转子前外侧，供应范围３．５ｃｍ×２．０ｃｍ×３．５ｃｍ。结论：以旋股外侧动脉横支为蒂大转子骨瓣移位修复股骨中段或上段骨缺损具有可行性，临床应用１５例，疗效满意。     

旋股外侧动脉横支联合臀中肌支大转子骨(膜)瓣的应用解剖

目的:进一步为临床应用大转子骨(膜)瓣移位术提供解剖学基础及手术方式。方法:在52侧经股动脉灌注红色乳胶的成人下肢标本上,重点对旋股外侧动脉横支、升支的臀中肌支走行、分布及臀中肌的形态、血供来源进行解剖学观测。结果:旋股外侧动脉横支起始点外径(2.5±0.8)mm,其上行支分布于大转子前外侧部,供血范围4.0cm×2.0cm×3.5cm,下行支分布于股骨前外侧的骨膜,供血范围9.7cm×4.6cm。臀中肌支起点至入肌点的距离为(3.5±0.8)cm,血管在近臀中肌止点处有小动脉穿出至大转子上部和外侧面。臀中肌由多条血管供血,诸血管肌支在肌肉内形成丰富的血管吻合网。结论:可设计旋股外侧动脉横支联合升支的臀中肌支为蒂大转子骨(膜)瓣,移位治疗股骨头缺血性坏死、股骨颈骨折、股骨中上段缺损的手术方式,并具有血供可靠、操作简便、术式灵活多样等特点。     

以内踝前或跗内侧血管为蒂第一楔骨瓣转位术的应用解剖

在30侧成人下肢标本上,解剖观测了第一楔骨动脉的来源、走行、分支和分布.内踝前动脉和跗内侧动脉恒定地紧邻胫骨前肌腱两侧走行,分别发2～6支和2～9支外径0.2～0.8mm的骨膜支至第一楔骨背内侧面.以内踝前血管或跗内侧血管为蒂可截取约1.5×1.0×0.5cm大小的骨瓣,经摹拟手术和临床应用,证实是修复距骨颈骨折、距骨体缺血性坏死以及踝足部诸关节植骨融合的一种简易可行的新术式.     

距骨的动脉供应及临床意义

在58侧不同年龄的新鲜下肢解剖,观察了距骨的血供,其中分布到距骨颈上面的滋养动脉主要来自跗内侧动脉和内踝前动脉。分布到距骨体的远端跗骨窦动脉来自跗外侧动脉,近端跗骨窦动脉主要来自外踝前动脉,三角支来自胫后动脉下段,并向前下方分出跗骨管动脉。     

带血管股骨片作支撑体阴茎再造的解剖基础

在45侧成年男性下肢标本上,观测了股中间肌近端的动脉来源、分支,走行和旋股外侧动脉降支。股中间肌近端动脉来源较多,发于旋股外侧动脉的57.7%,其骨膜支长3.6cm,发出后向下斜行至骨面,贴骨面呈节段分布,长达6.0cm 以上。旋股外侧动脉降支外径3.2mm,长9.2cm。经尸体摹拟手术,可设计以该血管为蒂的股骨瓣作支撑体与股前外侧皮瓣转位再造阴茎。本文对手术设计、骨片切取和血管蒂的处理等有关应用解剖学要点进行了讨论。     

旋股外侧血管蒂复(联)合组织瓣移植的解剖学基础

目的：为以旋股外侧血管蒂复(联)合组织瓣移植提供解剖学基础。方法：50侧成人下肢标本解剖观察旋股外侧动脉分支起始类型及其分布。结果：旋股外侧动脉分支起始主要有3型：Ⅰ型：旋股外侧动脉发升支、横支和降支占76％；Ⅱ型：升支、横支、降支由两干从股深动脉或股动脉发出占20％；Ⅲ型：升支、横支、降支单独从股深动脉或股动脉发m占4％。升支恒定分支分布于阔筋膜张肌和髂嵴前外侧部；横支分支分布于股外侧肌上部和大转子前外侧部；降支分支分布于股外侧肌和股前外侧部皮肤。结论：76％可以旋股外侧血管为蒂形成：①升支阔筋膜张肌皮瓣和／或髂骨瓣；②横支大转子骨瓣或骨膜瓣；③降支股前外侧皮瓣。20％则可以升支和横支或横支和降支共十形成相应两个组织瓣：     

跟外侧动脉的显微外科解剖

目的探讨跟外侧动脉的起始、行程、分支和分布等情况,为临床实践提供解剖学资料。方法在12侧经股动脉灌注红色乳胶溶液的成人下肢标本上,对跟外侧动脉进行显微外科解剖,观察其出现率并测量其起始位置、起始处及穿深筋膜处的口径。以外踝尖为基点,对外踝尖上6 cm范围内每2 cm间隔内跟外侧动脉分支的蒂长和口径进行测量并作统计学分析。另取小腿动脉血管造影标本5例,进一步观察跟外侧动脉行程及其与跟腱表面皮瓣血供的关系。结果跟外侧动脉于外踝尖上4.9～9.4(6.56±1.30)]cm处源自腓动脉,起始处口径为1.0～3.3(1.78±0.60)mm,穿深筋膜处口径为0.44～2.0(0.81±0.40)mm。其全程呈"L"型,垂直段共有2～5(2.50±0.80)支分支。在外踝尖上0.00～2.00、2.01～4.00、4.01～6.00 cm间隔内,分支的蒂长和口径分别是:(0.81±0.31)、(1.68±0.55)、(1.59±0.41)cm和(0.80±0.31)、(0.80±0.11)、(0.85±0.23)mm。垂直段分支分支纵、橫穿行,纵者吻合成链状与腓肠神经及小隐静脉伴行,参与腓肠神经营养血管皮瓣供血系统的组成,橫行者越过跟腱浅面与来自胫后动脉的分支吻合,供养跟腱区皮瓣;水平段分支3～5支,分布于足外侧面后侧约1/3皮肤软组织。结论跟外侧动脉是腓动脉的直接延续,尸体标本和活体标本中跟外侧动脉出现率分别为100%和80%;跟外侧动脉既参与腓肠神经营养血管皮瓣供血系统的组成,又营养跟腱表面的皮瓣。     

The lateral calcaneal artery

An anatomic study of the lateral extraosseous and intraosseous arterial supply of the calcaneus and the lateral soft tissue was carried out on 10 fresh lower adult cadaver legs using different anatomic and radiologic procedures (plastination, modified Spalteholz clearing technique, digital subtraction and rotational angiography and computed tomographic angiography). Consistent patterns of extraosseous and intraosseous lateral calcaneal vascular anatomy were demonstrated. The lateral calcaneal artery is a branch of the anterior tibial artery which crosses over the calcaneal tuberosity and forms a large lateral arch with the lateral tarsal artery which is a branch of the dorsalis pedis artery. The intraosseous circulation is supplied laterally by the lateral calcanear artery, medially via the short branches of the lateral plantar artery. Comparing magnet resonance images after fresh calcaneal fractures the lateral calcanear artery may be interrupted by the impacted lateral bulge, by the conventional lateral surgical approach, or by applying a lateral osteosynthesis plate. This may cause avascular bone necrosis. Furthermore the lateral calcanear artery can clinically serve as a vascular pedicle for a local rotational skin flap to cover soft tissue defects of the heel.     

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.     

Anatomical consideration of vascularized bone graft transfer from the medial calcaneus to the talus

To investigate the possibility of use of the calcaneal branches of the posterior tibial artery as the pedicle for the vascularized bone graft to the talus, a detailed anatomical study was carried out on 30 fresh cadaver feet. Although there are several branches from the posterior tibial artery to the calcaneus, the largest posterior branch was defined as the main calcaneal branch. We recognized frequently a large branch nourishing the superior part of the calcaneus and named it the superior calcaneal branch. Twenty feet had the superior calcaneal branches. Pedicled bone grafts using the superior calcaneal branch to the postero-medial portion of the talar body were possible in 18 of 20 feet. Pedicled bone grafts using the main calcaneal branches were possible in 9 of 12 feet in which the superior calcaneal branches were not available. Finally, vascularized bone grafts were judged to be feasible in 27 feet (90%).     

腓骨头血供的应用解剖学

在30例成人、10例儿童、2例胎儿尸体下肢上,对腓骨头血供进行应用解剖学研究。胫前返动脉,旋腓骨支和膝下外侧动脉在腓骨头外形成动脉吻合网。腓骨滋养动脉上升支供养腓骨头内松质骨。研究结果认为:在成人作腓骨头移植时可以腓动脉为蒂:若在儿童作腓骨头移植时,除了吻合腓血管外,最好同时吻合膝下外侧动脉,以充分保证骨骺的血供。     

跟腱血供的显微外科解剖及其临床意义

目的：研究跟腱血供的显微外科解剖,为跟腱手术提供参考数据。方法：采用新鲜及下肢固定的标本各１５例,注射红色乳胶,用体视显微镜观测。结果：跟腱血供来自胫后动脉和腓动脉,其分支为跟腱深动脉,内侧动脉、外侧动脉及跟内,外侧支。结论：跟腱深动脉为跟腱的主要营养血管,另在跟腱的内,外侧及下端分别形成动脉网。跟腱的外膜内尚有丰富的膜内动脉网。     

以腓动脉终末穿支为蒂的皮瓣应用解剖

在33侧成人标本上,观察了以腓动脉的终末穿支为蒂的外踝上皮瓣血供。腓动脉终末穿支在外踝上方5.9cm 处,穿出骨间膜,外径为1.7mm,本干长为0.7cm,分为升支和降支、有91%的个体,以穿动脉的升支为蒂,设计为外踝上皮瓣:以穿动脉的降支为蒂,设计为足外侧皮瓣。在9%的个体中,腓动脉穿支细小,不能作为皮瓣的血管蒂,只能改用外踝前动脉升支为蒂的外踝上皮瓣.     

The lateral calcaneal artery: Anatomic basis for planning safe surgical approaches

The proximity of the lateral calcaneal artery (LCA) to surgical incisions applied to the lateral hindfoot makes it vulnerable to iatrogenic injury and subsequent postoperative skin necrosis. This study aimed to investigate the course of the LCA and to define anatomical points that can be used by surgeons during lateral approaches to the calcaneus. Thirteen leg‐ankle‐foot specimens were dissected and the superficial course of the LCA was outlined by three anatomic points: (a) tip of lateral malleolus, (b) the point where it pierces the deep fascia, and (c) the point where it crosses the line connecting the lateral malleoluswith the insertion of Achilles tendon. Fifteen healthy volunteers were investigated by color Doppler ultrasound where the diameter and depth of LCA were measured. The LCA pierced the deep fascia at a maximum height of 4.5 cm (mean 3.78) above the midpoint of a line extending from the lateral malleolus to the insertion of Achilles tendon. It crossed the previous line at a maximum distance of 3 cm (mean 2.6) posterior to lateral malleolus. At this point, its mean diameter was 1.75 mm on the right and 1.73 mm on the left sides, while its mean depth was 7.73 mm on the right and 8.0 mm on the left sides. A dangerous triangle that contained the superficial course of the artery was mapped out in the lower lateral part of the leg. This triangle should be considered during surgical approaches applied to the lateral hindfoot to avoid damage of the LCA. Clin. Anat. 22:834–839, 2009. © 2009 Wiley‐Liss, Inc.     

足背外侧动脉链岛状皮瓣的应用解剖

目的　探讨足背外侧动脉链的组成,为施行足背外侧动脉链岛状皮瓣手术提供解剖依据。 方法　用48侧成尸足,解剖观测外踝后动脉跟外侧支、外踝前动脉降支、跗外侧动脉与第四跖背动脉的外径、走行、吻合和分布范围。 结果　外踝后动脉跟外侧支为腓动脉的终末支,外径（1.0±0.3）mm。外踝前动脉降支外径（1.3±0.3）mm,沿外踝前缘向下走行,在外踝尖的水平分为前、后支,后支与跟外侧支吻合,占97.9%,吻合处的外径（0.8±0.3）mm;前支与跗外侧动脉吻合,占91.6%,吻合处外径（0.6±0.2）mm;跗外侧动脉发出分支与弓形动脉或第4跖背动脉吻合,占95.8%,吻合处的外径（0.6±0.2）mm。足背外侧皮神经与足背中间皮神经司足背外侧皮肤的感觉。 结论　上述4条动脉吻合形成足背外侧动脉链,扩大了足背外侧皮瓣的切取面积,增加了临床应用的灵活性。     

Anomalous branching order of the superior and lateral thoracic arteries

The superior thoracic and lateral thoracic arteries usually arise from the axillary artery as the first and second branches, respectively. Although anomalies have been described, no reports of a reversal of the order of origin have been found. In two cadaveric dissections, the lateral thoracic artery was found to arise cephalad to the superior thoracic artery. Clin. Anat. 10:394–396, 1997. © 1997 Wiley-Liss, Inc.