背阔肌肌皮瓣的血管解剖及其临床应用

目的 探讨背阔肌肌皮瓣与血供的关系,为肌皮瓣的再划分、转位及移植提供解剖学基础。方法 用大体解剖学、血管X 线造影方法,对48例尸体背阔肌进行观察,并回顾背阔肌肌皮瓣进行临床应用31例的效果。结果 背阔肌肌皮瓣有多个血供来源,其中胸背动脉主干分布于背阔肌外上部。恒定地分出内侧支和外侧支,具有各自分布区域。背阔肌内下部由肋间动脉和腰动脉供应。据X 线造影所见,它们与胸背动脉分支间吻合明显,口径在320～550 μm之间。背阔肌表面皮肤血供均来自深方肌皮穿支,越向内下方,穿支间吻合稀疏,口径亦细小。临床应用肌皮瓣做肿物切除后创面修复,乳房再造,修复小腿缺损等共31例,术后肌皮瓣30例完全成活,1例肌皮瓣远端早期出现部分血运障碍征象,经对症处理后,血运逐步改善,伤口延期愈合。 结论 背阔肌肌皮瓣,按其动脉分支及其吻合特点可分为3个部分,为整体或部分分离、转位或移植,保持肌功能提供血管解剖基础。     

以节段性肌肉移植为目的的股薄肌应用解剖

目的对股薄肌的主次血管蒂进行显微解剖,为节段性移植提供参考。方法解剖40例福尔马林保存的股薄肌标本,采用一种比例测量法,解剖及测量动脉蒂以及神经和血管的伴行关系。通过将每1例标本营养血管的位置比例化,总结肌肉动脉及神经分布的规律。结果股薄肌有4条动脉供血,其中股深动脉/旋股内侧动脉肌支和股动脉肌支是恒定出现的两条营养动脉,管径粗大、长度充分,适于游离移植。它们分别在距肌肉近端1/5与距肌肉后缘2/3相交的位置、和距肌肉近端1/2与距肌肉后缘1/2相交的位置进入肌肉,95%的神经和血管伴行。结论股薄肌可以凭借主要营养动脉分支为蒂纵行游离移植,或分别以主次营养动脉为蒂横行游离移植。     

颈浅动脉游离皮瓣的应用解剖

目的：为开发颈浅动脉游离皮瓣的应用提供解剖学基础。方法：解剖观测３０ 侧成人尸体标本颈横动脉及其浅支的起源、走行、分支、分布及其吻合情况,对其肌皮穿支进行体表定位。结果：颈浅动脉为颈横动脉的主要分支。颈横动脉起点至斜方肌前缘５ ．５ ±０ ．８ ｃｍ 。颈浅动脉起点外径２ ．１ ±０ ．３ｍ ｍ ,有２ 条伴行静脉。其肌皮穿支恒定的有２ 支,血管蒂长７ ～８ ｃｍ 左右。结论：颈浅动脉有恒定的肌皮穿支,体表定位明确,血管蒂较长,管径较粗,吻合丰富,有２ 条伴行静脉,可以形成颈浅动脉游离皮瓣。     

三角肌前束肌蒂锁骨瓣移位术的应用解剖

目的：为带三角肌前束肌蒂锁骨瓣转位术提供解剖学基础。方法：在５０侧成人上肢标本上解剖观测三角肌前束形态,共及其与锁骨的关系。结果：三角有束前缘平均长１６．５ｃｍ,前束在与中间束交界处长１４．６ｃｍ,前束起始于锁骨部宽５．９ｃｍ。神经血管束入肌门的体表投影点在肩峰角下５．６ｃｍ,约在前束前缘外后方３．５ｃｍ。肌蒂游离长度达１２．６ｃｍ。结论：可设计以三角肌前束为蒂的锁骨瓣转位修复肱骨上段骨不连、骨缺     

手内在肌的血供与肌瓣设计的解剖学基础

目的:研究手内在肌的血供为肌瓣的设计提供解剖学基础。方法:(1)红色乳胶灌注的上肢标本20侧,解剖并观测手内各动脉的起始部位,测量其管径及其走行,分支、分布情况等。(2)动脉灌注明胶-氧化铅混悬液的新鲜成人整尸标本10具,解剖取下各手内在肌,拍摄X线片。利用Photoshop与ScionImage对X线影像进行分析处理,观测营养动脉在肌内的分布、分型及彼此间的吻合情况等。结果:18块手内在肌共有(58.0±5.9)支动脉供血,平均(3.0±1.0)支,平均外径及其供血区域的长度与宽度分别为:(0.8±0.2)mm,(2.2±0.4)cm,(1.0±0.2)cm。结论:(1)手内在肌的血运丰富,其起、止点处的血管网亦丰富,具备切取肌瓣或肌骨(膜)瓣的解剖学基础。(2)其中有9块肌肉的主供血动脉之管径较粗大且恒定,易于解剖与取瓣,可供临床选用。     

三角肌的血供特点及临床意义

目的 :为临床应用三角肌皮 (骨 )瓣提供应用解剖学基础。方法 :5 0侧成人上肢标本 ( 10侧动脉铸型标本 ) ,观察三角肌形态、血供来源、分布特点及神经支配 ;2例新鲜上肢标本经锁骨下动脉灌注含有银珠粉的显影剂 ,X线拍片 ,观察动脉在三角肌内的分布、构筑特点。结果 :三角肌前部肌束血供来源于胸肩峰动脉的三角肌支和肩峰支 ,其血管神经束在肩峰角下 5 .6cm入肌 ;中后部肌束血供主要来源于旋肱前动脉和旋肱后动脉 ;三角肌由腋神经支配 ,其主干的体表投影位于肩峰平面下方 ( 5 .3± 1.7)cm ;三角肌后缘前方 ( 4 .2± 1.2 )cm和肩峰前角与三角肌粗隆连线后方 ( 1.3± 1.1)cm处。结论 :三角肌血供丰富为多源性 ,血管径粗、蒂长、体表易定位 ,有神经伴行 ,可以制成带感觉的肌皮骨瓣用以修复软 (骨 )组织缺损     

Arterial anatomy of the gracilis muscle as determined by latex injection and glycerin transparency

The gracilis muscle is widely used in reconstructive surgery, either as a pedicled flap or as a free microsurgical flap. The aim of this study was to demonstrate in detail the arterial anatomy of the gracilis muscle, particularly its intramuscular artery distribution, by using a method involving red latex injection and glycerin transparency, which makes muscle tissues quite transparent and allows direct visualization of the arterial anatomy. Twenty-four specimens of gracilis muscle were harvested after injecting 12 cadavers with red latex. The different patterns of blood supply of the gracilis muscle were counted. A complete arterial system formed by anastomoses of intramuscular arterial branches was observed in each specimen. The existence of several arterial branches at the proximal origin of each muscle was observed. The results of this study provide reconstructive surgeons with useful information regarding gracilis muscle flap design.     

缺氧内皮细胞培养液对肺动脉平滑肌细胞表型的影响

用细胞培养和形态定量分析方法观察缺氧对肺动脉平滑肌细胞表型的影响。结果显示，缺氧性内皮细胞条件培养液组肺动脉平滑肌细胞的二倍体细胞和α－ｓｍ－ａｃｔｉｎ含量均少于常氧性内皮细胞条件培养液组（Ｐ＜０．０５），尤以肌丝成份减少最明显；粗面内质网和线粒体却显著增多。而直接缺氧组与常氧组无明显差异。提示：缺氧可促使内皮细胞产生和释放某种促平滑肌细胞表型转化的物质或因子，从而改变了肺动脉管壁细胞之间的正常调控关系，导致平滑肌细胞肥大，合成细胞外基质增多。     

Vascular anatomy of a dicephalic cat

Summary The arterial and venous systems of the neck and heads of a dicephalic iniodymic monosomic cat are described. In the arterial system, an anomalous lingual branch of the right external carotid formed a large subhyoid arch, extending to the midline between both heads, giving off branches supplying the medial aspect of both heads and terminating in two medial internal carotid arteries each for the right or left head. This vessel was considered as an anomalous supernumerary common carotid artery. In the venous system, each lingual branch of linguofacial veins united and formed an anomalous venous arch. It received rostrally a long midline vein running between both heads and connecting with the medial internal jugular system. This vein received tributaries from the left and right heads and was considered as a supernumerary jugular vein. From these observations, and those of others in the literature, it can tentatively be suggested that, in congenital cephalic duplications in domestic mammals, the arterial blood supply for the medial aspect of both heads tends to come from the lingual branch of the external carotid artery, with an unexplained prevailing contribution of the right external carotid system. Two different venous patterns have been observed. In animal especies exhibiting a hyoid venous arch, such as carnivores, a midline supernumerary external jugular vein draining at the anomalous junction between lingual veins of both heads is formed, whilst in animals lacking a constant hyoid venous arch, such as ruminants, an asymmetrical supernumerary external jugular vein draining into the right normal external jugular vein has been repeatedly described.     

腹腔镜前路L5～S1椎间盘手术的血管解剖观察

目的:阐明髂间三角区内血管的分布规律,为腹腔镜前路L5～S1椎间盘手术提供安全靶区。方法:31例经动脉灌注红色乳胶的成人防腐固定腰椎标本,年龄58.2岁。观测并分析髂间三角内与腹腔镜前路L5～S1椎间盘手术相关的血管解剖数据。结果:L5～S1椎间盘的高度、宽度分别为(1.87±0.21)cm、(5.07±0.60)cm;主动脉杈(AB)与髂总静脉汇合处(CCIV)分别位于L5～S1椎间盘上缘(3.97±1.24)cm、(2.75±1.46)cm处;夹角分别为(52.4±12.0)°、(78.4±22.1)°;骶正中动脉(MSA)存在于所有的标本中,在L5～S1椎间盘上、下缘处的外径分别为(0.16±0.04)cm、(0.14±0.05)cm;上、下缘水平到右髂动脉(RIA)的距离分别为(2.02±0.81)cm、(2.74±0.83)cm。左髂静脉(LIV)到右髂动脉的平均距离为3.60cm,占椎间盘宽度的71.3%(32.3%～124.4%)。结论:髂间三角内的血管解剖能满足腹腔镜前路L5～S1椎间盘手术要求,可作为手术治疗椎间盘疾患的选择靶区。     

Arterial supply of the gracilis muscle and its relevance for the dynamic graciloplasty

The various methods of transposition of the gracilis muscle in order to serve as an anal neo‐sphincter have progressed in recent years. Tetanic contraction can be achieved by converting Type II muscle fibers into Type I by use of chronic, low frequency electrical stimulation. In order to guarantee a good function the muscle's vascularization has to have at least one nutritive vessel. In our investigation we worked out the various forms of the muscle's arterial blood supply. Dissecting 66 specimens we detected four with only one nutritive vessel, 23 with a double‐supply and, as the most common constellation, in 34 cases three supplying arteries. A small group of five individuals showed more than three arterial vessels. Because of the fact that the obturator nerve is not running with the incoming arteries, an angle was measured between the length axis of the muscle and the first perforating artery. This information should help the surgeon to preserve the nerve. Clin. Anat. 12:159–163, 1999. © 1999 Wiley‐Liss, Inc.     

颏下皮瓣的应用解剖学研究

目的:为应用颏下皮瓣修复面部组织缺损提供解剖学依据。方法:在25侧经红色乳胶灌注的成人标本上,对颏下区的血管及神经进行了较为详细的观测。结果:颏下动脉恒定起自面动脉,在距其起点(27.16±1.21)mm处发出。起点处的直径(1.86±0.96)mm。颏下动脉起点距下颌角和颏部中点的距离分别为(19.34±5.06)mm和(62.88±6.09)mm。颏下静脉的直径(1.97±0.73)mm。结论:本研究提供了颏下区详尽的解剖学数据。揭示了颏下区血管神经的位置和相互关系。为颏下皮瓣的制备提供了解剖学依据。     

第三腓骨肌瓣的应用解剖

目的　为小腿下 1/3骨髓炎和其它创伤性修复提供满意的肌瓣。材料和方法　用 18具 3 6例成人尸体标本采用连续层次解剖法 ,调查了第三腓骨肌 ,用游标卡尺测量了有关数据。结果　转动第三腓骨肌瓣能覆盖胫骨前内侧下 1/3的面积为 ( 16 7± 8 1)cm2 的区域。结论　第三腓骨肌可以移植。     

A case of muscle subclavius posticus with special reference to its innervation

Summary A subclavius posticus muscle was found in the left side of a Japanese male cadaver. This muscle arose from the first costal cartilage, inserted to the upper margin of the scapula, and was innervated by a branch from the nerve to the subclavius. This excess intermediary muscle between the subclavius and the inferior belly of the omohyoid appears to be more closely related to the subclavius, based on detailed examination of the innervation of this muscle. A possible schematic model of the origin of this muscle is proposed.

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Un cas de muscle subclavius posticus — Étude spéciale de son innervation

Résumé Un muscle subclavius posticus a été découvert du côté gauche d'un cadavre Japonais de sexe masculin. Ce muscle s'étendait du premier cartilage costal au bord supérieur de la scapula et était innervé par une branche du nerf du m. subclavier. Ce muscle accessoire situé entre le m. subclavier et le ventre inférieur du m. omo-hyoïdien semblait plus étroitement lié au m. subclavier en raison des conclusions de l'analyse détaillée son innervation. Une proposition de modèle schématique de l'origine de ce muscle est avancée.

     

带蒂筋膜瓣和骨膜瓣肘关节成形术的应用解剖

目的：为肘关节成形术填充物的选用提供解剖学基础。方法：在４０侧经动脉灌注颜料的上肢标本上,解剖观测了臂内、外侧筋膜,前臂后筋膜和尺、桡骨前部骨膜的血管来源、分支分布;血管蒂长度及筋膜瓣、骨膜瓣的切取面积等。结果：观测了以尺、桡侧返动脉为蒂的臂内、外侧筋膜瓣;以骨间后动脉为蒂的前臂后筋膜瓣;以骨间前动脉为蒂的尺、桡骨前部骨膜瓣。这些瓣膜的血管蒂长,血供丰富,可取面积大,质地坚韧致密。结论：上述带血管蒂的筋膜瓣和骨膜瓣可作为肘关节成形术的填充物,讨论了临床应用解剖学要点     

Anatomic basis for use of a gracilis muscle flap

Summary The aim of this study was to specify certain anatomic features of the gracilis m. with a view to the use of muscular or myocutaneous flaps. It was based on dissection of 84 gracilis muscles in 42 subjects as well as selective injection of the main pedicle of 20 muscles. This established the following points : 1) The arterial supply is abundant, consisting of several pedicles reaching the muscle on its deep aspect. The main neurovascular pedicle arises from the deep vessels of the thigh, via either the a. of the adductors (73%), the medial circumflex a. (19.2%) or as a double supply from both arteries (7.7%); 2) The cutaneous vascularisation over the gracilis m., derived from the solitary main pedicle, is inconstant. In 20 injections, it was satisfactory in 11 cases, poor in 5 and absent in 4; 3) The distal tendon of the gracilis m. is closely related to the posterior branch of the saphenous n. to the leg, which it crosses in an elongated X; 4) A simple method of calculation based on the distance between the upper border of the pubis and the medial femoral epicondyle allows quite precise determination of the point of entry of the main pedicle into the gracilis m. 5) Complete dissection of the main pedicle adds to the available length of the muscle flap.

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Bases anatomiques de l'utilisation d'un lambeau du muscle gracile

Résumé Cette étude a pour objet de préciser certains aspects anatomiques du muscle gracile en vue de l'utilisation de lambeaux musculaires ou musculo-cutanés. Elle repose sur la dissection de 84 muscles graciles chez 42 sujets ainsi que l'injection sélective du pédicule principal de 20 muscles graciles. Elle a permis de préciser les points suivants : 1) L'irrigation artérielle est riche, faite de plusieurs pédicules abordant le muscle par sa face profonde. Le pédicule principal vasculo-nerveux est issu des vaisseaux profonds de la cuisse soit par l'artère des adducteurs (73 %), soit par l'artère circonflexe médiale (19,2 %), soit par un double apport de ces deux artères (7,7 %); 2) La vascularisation cutanée en regard du muscle gracile à partir du seul pédicule principal est inconstante. Sur 20 injections elle est satisfaisante 11 fois, pauvre 5 fois et absente 4 fois; 3) Le tendon distal du muscle gracile est étroitement en rapport avec la branche postérieure jambière du nerf saphène qu'il croise en X allongé; 4) Une méthode de calcul simple à partir de la distance entre le bord supérieur du pubis et l'épicondyle médial permet de déterminer avec une bonne précision le point de pénétration du pédicule principal dans le muscle gracile; 5) La dissection complète du pédicule principal améliore la longueur disponible du lambeau musculaire.

     

股前内侧穿支皮瓣的应用解剖学研究

目的　为股前内侧穿支皮瓣的临床应用提供解剖学基础。 方法　新鲜成人尸体20具(40侧),行一次性全身乳胶灌注5具,全身动脉造影15具。通过直接层次解剖,应用图像分析和测量系统　Scion image,对股前内侧穿支进行定性、定量分析;螺旋CT扫描数据以Dicom格式输入Mimics图像工作站对该区穿支皮瓣进行三维重建。 结果　股前内侧区共有外径≥0.5mm的穿支(21.0±4.0)支,外径　(0.8±0.1)mm,蒂长(4.5±2.1)cm,穿支的平均供血面积(44±4.8)cm2。将股前内侧区分为上、中、下3区,发现三个区域均有穿支供应相应区域皮肤,中1/3区是穿支分布最集中的区域,多为肌皮穿支,主要由股动脉主干,旋股外侧动脉起始部,以及膝降动脉的穿支供血。 结论　股前内侧区穿支丰富,穿支蒂的来源因解剖部位而不同,在中1/3区穿支出现率较为恒定,设计股前内侧穿支皮瓣是切实可行的。     

前臂背侧皮瓣的应用解剖

用显微解剖、组织切片及扫描电镜观察等方法对40例成人前臂背侧皮瓣进行了究研.前臂背侧皮瓣的供血动脉为骨间后动脉,外径为1.5mm,主干长15.4cm,在浅筋膜及深筋膜中有丰富的吻合支.该皮瓣的微血管构筑由五层血管网组成。各层血管网间有丰富的吻合支,互相沟通,共同完成整个皮瓣的血供.该皮瓣具有血管口径粗,位置恒定且浅表不损伤主要血管等优点.