咽升动脉分支的解剖分组及其临床意义

目的探讨咽升动脉及其主要分支在颈部颅底区域走行规律及其在血管内外治疗中的临床意义。方法选择以10%甲醛固定并用乳胶灌注的8具(16侧)成人颅颈部标本, 自颈总动脉分叉水平向上解剖至颅底骨质, 分离显露咽升动脉及周围相关结构, 观察咽升动脉的起源部位及主要分支, 测量相关解剖学参数。依据咽升动脉主要分支与颈动脉鞘的位置关系分为颈动脉鞘内、外2组, 观察2组分支血管的走行规律及解剖分布特点。结果 8具16侧标本中:咽升动脉13侧自面动脉起始点平面以下的颈外动脉发出, 2侧起源于枕动脉, 1侧与枕动脉共干起源于颈外动脉;14侧咽升动脉沿颈内动脉腹侧上行(15.39 ± 3.20)mm后发出主要分支咽干和脑膜干, 2侧变异。脑膜干自咽升动脉主干发出(9.32 ± 3.20)mm后均穿入颈动脉鞘, 上行分叉后经舌下神经管或颈静脉孔或鼓室小管下口或枕大孔入颅;咽干则在颈动脉鞘外走行并分布于咽旁、椎旁等区域。颈动脉鞘内组包括脑膜干和鼓室下动脉, 均穿入颈动脉鞘后沿颈内动脉内侧上行;颈动脉鞘外组包括咽干和肌支, 于鞘外走行。结论咽升动脉及其分支变异显著、走行复杂, 可按照咽升动脉各主要分支与颈动脉鞘的...     

眶下血管蒡鼻唇沟皮瓣的解剖与临床应用

观察６具１１侧成人尸体标本眶下血管、神经分支走行和分布。眶下动脉出眶下孔有－分支与眶下神经分支伴行，经提上唇肌与颧小肌之间分布至鼻唇沟区域皮下，与面动脉、面横动脉的分支吻合构成血管网。该血管分支有三种类型：（１）与上唇支共干、（２）与下睑支共干。血管长度平均为１．３ｃｍ，外径约０．１－０．８ｍｍ。从而提出以眶下动脉分支及附带少许皮下组织为蒂轴型皮瓣，应用临床整复鼻面部小面积皮肤软组织缺损７例，效果     

咽升动脉分支的解剖分组及其临床意义

目的:探讨咽升动脉及其主要分支在颈部颅底区域走行规律及其在血管内外治疗中的临床意义。方法:选择以10%甲醛固定并用乳胶灌注的8具（16侧）成人颅颈部标本,自颈总动脉分叉水平向上解剖至颅底骨质,分离显露咽升动脉及周围相关结构,观察咽升动脉的起源部位及主要分支,测量相关解剖学参数。依据咽升动脉主要分支与颈动脉鞘的位置关系分...     

以颈横动脉浅支为蒂肩胛冈骨瓣枕颈融合术的应用解剖

目的：为枕颈融合术提供带血管蒂骨瓣转位术的应用解剖学基础。方法：在３０侧经动脉灌注红色乳胶的成人尸体标本上，解剖观测颈横动脉浅支的走行、分支及分布；另在１侧标本上摹拟手术设计。结果：颈横动脉浅支主要分支有肩胛冈支和斜方肌支。肩胛冈支外径１．６±０．３ｍｍ，长度４．９±０．６ｃｍ；斜方肌支可分为升支和降支，其中升支水平横向正中线，在第７颈椎棘突附近与颈深动脉后支及邻近皮支相吻合，斜方肌支—升支长达６．７ｃｍ，起始外径１．５±０．３ｍｍ。结论：在颈横动脉肩胛冈支和斜方肌支分支前结扎动脉干，可以斜方肌支—肩胛冈支为蒂设计肩胛冈骨瓣转位行枕颈融合的术式。     

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。     

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：     

多束血管植入治疗股骨头缺血性坏死的解剖学基础

在３０侧成人下肢标本上观察了旋股外侧动脉升支的二，三级分支。升支通常在阔筋膜张肌肌门处分为上，下（一级）肌支，上，下肌支肌内均分出２－４支外径０．５－１．８ｍｍ的浅，深（二级）支，浅，深支在肌内分出７－９支外径０．５ｍｍ以下的三级分支。一，二级分支长为４．０－５．８ｃｍ。以升支带其各级分支可增加血管束的长度，植入的血管细小有利于血管新生。     

颊肌的解剖学研究及其临床意义

目的：阐明颊肌的血液供应,为新型颊肌粘膜瓣设计提供解剖学基础。方法：对10具新鲜尸体标本20侧面区进行解剖,从颈总动脉远心端注入红色乳胶,在2具尸体标本面静脉内注入兰色乳胶。显露颊肌及其血管和神经。结果：面动脉分别发出后颊支、下颊支和前颊支进入颊肌,后颊与颊动脉相互吻合。上齿槽后动脉和眶下动脉发出上颊支分别进入颊肌上界的后部与前部。这些分支相互吻合。颊肌静脉在颊肌后部形成颊静脉丛,分2～4支注入面静脉,或经颊静脉注入翼丛或上颌静脉。结论：面动脉为颊肌的主要供血动脉。以进入颊肌任何一方血管为蒂的颊肌粘膜瓣均可存活。本文设计了2种新的岛状颊肌粘膜瓣。     

以串连血管为蒂的股骨外侧髁骨(膜)瓣的应用解剖

目的：为治疗股骨干骨不连、骨缺损提供一种新的骨（膜）瓣供区。方法：在５０侧成人下肢标本上,解剖观察了膝上外侧动脉的起始、走行、分支分布及其与旋股外侧动脉降支的吻合类型。结果：膝上外侧动脉于股骨外侧髁上方（２．５ ± ０．５）ｃｍ处起自于腘动脉外侧壁,分出升支、横支和降支。升支和／或横支与旋股外侧动脉降支有 ３种类型的吻合,吻合率为 ９２％（４６侧）,吻合处外径为（１．３ ± ０．３）ｍｍ。结论：以旋股外侧动脉降支与膝上外侧动脉升支和／或横支串连为蒂可截取股骨外侧髁骨（膜）瓣用于修复股骨干骨不连及骨缺损。     

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 cephalic arterial system in dogs, especially on the anastomoses between the intracranial and extracranial circulations

The cephalic arterial system with a special reference to the anastomoses between the extracranial and intracranial circulations was investigated by means of the corrosion casts of 30 dogs. We researched into the cephalic arterial system in dogs according to Bugge's theory. His theory is as follows: ontogenetically it is composed of 4 arterial systems (the internal and external carotids, vertebral and stapedial arteries), although these arteries trans-figure from the primitive basic pattern to the adult one with particular anastomoses between the branches in each of the species. The modification of this basic pattern occurs as a result of the obliteration or persistence of certain parts of the 4 original arterial systems when they are accompanied with various anastomoses. And he emphasizes that the mode of the appearance of each anastomosis is constant in each of the species. In this paper the obtained result is as follows. The stapedial artery that occurred in an early stage of embryonic period obliterates the proximal part except for the supraorbital, infraorbital and mandibular branches. Anastomosis X between the vertebral and external carotid arteries is formed in all the cases. Anastomosis Y between the internal carotid and ascending pharyngeal arteries is found at 20% on the right side and 30% on the left. Anastomosis a1 between the internal ophthalmic artery and each of the orbital arteries derived from the supraorbital branch is recognized at 93% on the right side and 97% on the left, and the other a1 between the internal ophthalmic artery and anastomosis a6 is formed in 7% on the right side and 3% on the left. Anastomosis a2 between the supraorbital and infraorbital branches is recognized in all the cases. Anastomosis a3 between the distal part of the external carotid artery and the proximal portion of the mandibular branch is found out in all. Anastomosis a4 between the distal portion of the internal carotid artery and the supraorbital branch or each of its distal branches in the orbita is recognized at 90% on both sides. Anastomosis a5 between the distal part of the internal carotid artery and the proximal part of the infraorbital branch or the middle meningeal artery is found at 97% on the right side and 87% on the left.(ABSTRACT TRUNCATED AT 400 WORDS)     

Prevalence of arterial branches arising from the extracranial internal carotid artery on CT angiography

Although it is well known that arterial branches may rarely arise from the cervical internal carotid artery (ICA), their incidence has not been adequately evaluated on computed tomography angiography (CTA). We investigate the prevalence of congenital and non-congenital anomalous branches arising from the cervical ICA by a 5 year retrospective review of neck CTAs performed on 2,602 patients. We found a higher frequency of arteries arising from the ICA than suggested by the existing literature, including a 0.49 % prevalence of the occipital artery origin and a 6.25 % prevalence of the superior pharyngeal branch of (the pharyngeal trunk of) the ascending pharyngeal artery. In addition, six cases of recanalized intersegmental arteries providing collateral flow to the cervical ICA from the cervical vertebral artery were identified. This is the first large, retrospective CTA study evaluating the incidence of these anomalous vessel origins.     

Persistent cervical intersegmental artery and aortic arch coarctation

A 15-year-old girl presented with upper extremity hypertension and continuous precordial murmur. Arteriography revealed aortic coarctation proximal to the origin of the left subclavian artery. An anomalous artery originated from the aortic arch, between the left common carotid artery and the stenosis. It ascended cranially and filled an angiomatous vascular formation on the left side of the neck. The "angioma" drained into the left subclavian artery. The embryological explanation of the described anomaly is difficult, but probably related to hemodynamic alterations following the prestenotic increase in blood pressure. This may have impaired the obliteration of cervical intersegmental arteries, resulting in the persistence of one of the first three intersegmental arteries as the anomalous branch of the aortic arch. The angiomatous vascular formation in the neck could be the consequence of altered development of anastomoses between the muscular twigs of both vertebral and deep cervical artery. The vessel draining the vascular formation was probably the thyrocervical trunk. Since there were no overt collateral channels or signs of left ventricular hypertrophy by electrocardiography and echocardiography, it seems that the aberrant collateral flow was hemodynamically significant and reduced the afterload on the myocardium. Although the pattern of collateral flow in our case might be considered extremely rare, it is important in preoperative planning and interpretation of imaging studies.     

下颈椎血供的解剖研究及其临床意义

目的为颈椎前路减压手术中减少出血量,改善显露和减少手术并发症的发生提供解剖学基础。方法在15具成人尸体标本上,解剖观测C3～7椎体前后部血供的起源、走行、分支及吻合。结果椎体前部血供来自颈升动脉脊支、甲状腺下动脉和颈深动脉脊支,C4～7椎前动脉在椎体上的分支相互吻合,在颈长肌的内侧缘处常吻合成一纵行动脉链;椎体后部血供来自椎间动脉发出的椎后动脉,其分支在颈椎体后部吻合形成节段性弧形动脉吻合链。结论阻断术椎的椎前动脉及其与相邻椎前动脉的纵行动脉吻合,并在颈椎后部减压时注意对硬膜囊外侧缘及椎体中部处的椎后动脉及其分支的处理,可减少颈椎前路减压手术的术野出血,改善手术显露。     

Bilateral variations of the vertebral arteries: The left originating from the aortic arch and the left and right entering the C5 transverse foramina

During the dissection course for second year medical students at the University of Toyama in 2005, we encountered variations of the bilateral vertebral arteries: the left directly came off from the aortic arch as the third branch between the left common carotid artery and the left subclavian artery and entered the transverse foramen of C5, instead of C6, whereas the right originated from the right subclavian artery and entered the transverse foramen of C5. The present vertebral artery of each side was possibly formed by the 6th cervical intersegmental artery linked with the longitudinal anastomoses between the cervical intersegmental arteries. Detailed knowledge of vertebral artery variations is crucially important for surgical treatment of blood vessels in the brain, neck and chest.     

Typology of the arteries in the human scalenus region, with special reference to the accessory ascending cervical artery

The accessory ascending cervical artery (Murakami et al., 1996), which arises from the subclavian artery and ascends between the scalenus anterior and medius muscles, was studied in 87 Japanese adult cadavers (174 sides), with special attention being given to its origin, distribution, and relationship to other arteries at the cervical or scalenus region. In 154 sides (88.5%), the accessory ascending cervical artery was found to originate from the subclavian artery behind the scalenus anterior muscle, and to branch out to the scalenus anterior and medius muscles as well as those entering the 5th and 6th intervertebral foramens along the 6th and 7th cervical nerves. This artery arose independently in 105 sides. The accessory ascending cervical artery issued off or formed a common trunk with the transverse cervical artery and/or costocervical trunk in 49 sides. In cases lacking the accessory ascending cervical artery, it was usually compensated for by the costocervial trunk and/or transverse cervical artery (18 sides). Common trunk formation with the vertebral, internal thoracic, or suprascapular arteries was not observed. The authors suggest that the accessory ascending cervical artery, the transverse cervical artery, and the costocervical trunk should be grouped into one arterial system, a system that may be a remnant of the precostal longitudinal anastomoses of intersegmental arteries of the dorsal aorta behind the scalenus anterior muscle.     

Comparative anatomical studies of thyroid and thymic arteries: I. Rat (Rattus norvegicus albinus)

The thyroid and thymic arteries were investigated in 50 male and 50 female rats. In more than 70% of the animals, on both sides the cranial thyroid artery forms a common trunk with the ascending pharyngeal artery. The caudal thyroid artery arises not from the deep cervical but from the pericardiacophrenic artery. It may be replaced, however, by a branch of some other artery, such as the brachiocephalic, subclavian, vertebral, or ascending cervical, suggesting a shift of its origin from the internal thoracic artery to the thyrocervical trunk as in man. All the thoracic lobes of the thymus are supplied directly by a thymic branch of the internal thoracic artery or indirectly by a branch of the pericardiacophrenic artery. More than half of the specimens have a cervical thymic lobe of variable size, which is supplied by a branch of the cranial thyroid, external carotid, and/or occipital arteries. Some of these thymic arteries, except those from the external carotid and occipital arteries, reach the thoracic lobe. The thoracic lobes lacking a cervical lobe may be supplied by the thymic branch arising only from the cranial thyroid artery. Other anomalous arteries supplying the thoracic lobe are derived from the superficial cervical and/or the right common carotid arteries. These results show that the thymic arteries of rats are basically similar to those of man, although they display a clear difference in their frequency and origin.     

Different ophthalmic artery origins: Embryology and clinical significance

This retrospective study gives a summary of ophthalmic artery (OA) variations to serve as guidelines for surgical interventionists and trainees. Pubmed and Medline searches were conducted. The OA usually arises intradurally (superomedial, anteromedial, or rarely superolateral) from the internal carotid artery (ICA). Rare extradural origin (primitive dorsal OA) (PDOA) remnant and extremely rare interdural origin (primitive ventral OA) (PVOA) remnant are of significance when sectioning the dural ring. Rarely, a persistent PDOA with ICA origin, or a PDOA remnant with inferolateral trunk origin, enters the orbit via the superior orbital fissure (SOF) for sole or partial orbital supply. Extremely rare, the PDOA and PVOA persist and form double OAs that arise from the ICA and run via the SOF and optic foramen. Occasionally, the OA arises from the middle meningeal artery (MMA), when both the PDOA and VDOA regress and enter the orbit via the SOF. Sole orbital supply via the external carotid artery (ECA), i.e. meningo‐ophthalmic artery and/or MMA branches, or dual OAs (ECA and ICA origins) may occur. Other rare OA origins include anterior or posterior communicating artery; anterior or middle cerebral artery; basilar artery; posterior inferior cerebellar artery; and the carotid bifurcation. Primitive arteries (persistent or remnant), and/or abnormal anastomoses play pivotal roles in manifestations of OA variations. Of clinical importance are orbital collateral routes and dangerous extracranial‐intracranial anastomoses. Awareness of OA origins and collateral routes is imperative for transarterial embolizations or infusion chemotherapy in the ECA territory to prevent visual complications. Clin. Anat. 28:576–583, 2015. © 2014 Wiley Periodicals, Inc.     

椎动脉椎前部的形态特点及临床意义

目的 :探讨影响椎动脉椎前部供血的解剖学基础。方法 :5 1例成人尸体标本 ,解剖观察椎动脉椎前部的主要毗邻结构 ,测量椎动脉椎前部两端管腔外径、长度及其与锁骨下动脉形成的角度。结果 :①椎动脉椎前部可分为正常型和先天异常型 ,其中正常型左侧椎动脉外径大于右侧 ,左侧椎动脉与同侧锁骨下动脉形成角度小于右侧 ,两者均具有统计学的显著性差异 (P <0 .0 5 ) ,但左右两侧椎动脉椎前部长度无显著性差异。②椎动脉椎前部前方有胸锁乳突肌 ;后方有第 7颈椎横突、颈交感干等结构 ,其中颈中、下神经节发出分支形成椎动脉丛并支配该动脉 ,后内侧邻接胸膜顶、颈长肌、头长肌、外侧为前斜角肌。结论 :正常成人左侧椎动脉椎前部较右侧为优势供血动脉 ,但是血管本身或毗邻结构改变有时可致椎动脉管腔狭窄 ,发生供血不足     

A case of the right aortic arch with the left subclavian artery as its last branch]

A case of the right aortic arch with the left subclavian artery as its last branch was found in an 80-year-old Japanese female cadaver during the 1990 dissection for students. The main findings were as follows. The ascending aorta arose from the left ventricle and ran right and upward to the level of the intervertebral disc between the 2nd and 3rd thoracic vertebrae. It then curved right and backward to form the aortic arch. The aortic arch joined the thoracic aorta that descended along the right side of the vertebral column and crossed obliquely the vertebral column at the level of the 8th thoracic vertebra. Finally it entered the abdomen through the aortic hiatus behind the esophagus. Four branches were given off from the aortic arch in the following order from left to right: the left common carotid, the right common carotid, and the right subclavian and the left subclavian arteries. The left subclavian artery, which had an aortic diverticulum at the origin of the aortic arch, ran left and upward behind the esophagus. The ligamentum arteriosum connected the left pulmonary artery with the aortic diverticulum of the left subclavian artery. The left common carotid artery, which normally had no branches before entering the cranium, gave off an accessory esophageal branch about 20 mm distally from its origin. The right and left vertebral arteries entered the transverse foramen of the 6th cervical vertebra. The left recurrent laryngeal nerve hooked around from the left dorsal to the right ventral part of the ligamentum arteriosum.(ABSTRACT TRUNCATED AT 250 WORDS)