带蒂展肌移植修复晚期面瘫的应用解剖研究

目的：为展肌移植治疗晚期面瘫提供形态学资料。方法：在５０侧成人下肢中观察了展肌的形态、血供和神经支配。结果：展肌位置表浅,位于足底肌的第一层,其血供和神经支配分别来自足底内侧动脉和神经,两者伴行,走行恒定。结论：展肌是修复晚期面瘫的理想供肌     

展肌游离移植的应用解剖学

对20侧新鲜成年尸足解剖,观测展肌的形态、血供和神经支配。该肌血供和神经支配分别来自足底内侧动静脉和足底内侧神经.可设计以足底内侧血管和足底内侧神经为蒂的展肌瓣,以期游离移植修复和重建面瘫等功能缺失。     

足底血管的巨微解剖

在60侧(男女各半)成人足标本上对足底血管进行了观察和研究.其结果,足底内侧动脉始端外径,男性为1.68±0.22mm;女性为1.32±0.19mm,男女性间有显著差异.足底外侧动脉始端外径,男性为2.00±0.27mm;女性为1.73±0.27mm,男女性间有显著性差异.与此同时,对足底动脉浅弓、足底动脉深弓的组成、位置、分支进行了分析,初步确定了足底内侧动脉和足底外侧动脉,足底动脉浅弓和足底动脉深弓的体表投影.     

带蒂拇展肌移植修复晚期面瘫的应用解剖研究

目的：为拇展肌移植治疗晚期面瘫提供形态学资料。方法：在５０侧成人下肢中观察了每展肌的形态,血供和神经支配。结果：拇展肌位置表浅,位于足底肌的第一层,其血供和神经支配分别来自足底内侧动脉和神经,两者伴行,走行恒定。结论：拇展肌是修复晚期面瘫的理想供肌。     

肌间隙血管为蒂小腿内侧皮瓣的应用解剖及临床应用

目的 :为胫后动脉的肌间隙分支为蒂小腿内侧皮瓣移植提供解剖学基础。方法 :选用新鲜尸体60侧经胫后动脉起始部进行墨汁注射 ,以内踝至胫骨平台将小腿等分成A、B、C、D 4个区段 ,在手术放大镜下进行解剖观察血管分支长度、口径、类型。结果 :B区胫后动脉肌间隙分支长 (4 .5± 0 .6)cm ,外径 (1.7± 0 .2 )mm。C区胫后动脉肌间隙分支长 (4 .0± 0 .6)cm ,外径 (1.5± 0 .3 )mm。其余A、D区分支细、短。结论 :以胫后动脉的肌间隙支为蒂小腿内侧皮瓣血管蒂较长 ,口径适合显微外科的吻合要求 ,可用于游离移植修复 ;临床修复手皮肤缺损 6例 ,皮瓣全部成活。     

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。     

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。     

模拟足拇展肌与拇收肌移位吻接术生物力学性质实验研究

研究了正常拇展肌、拇收肌拉伸力学性质和模拟拇外翻拇展肌，拇收肌移位吻接术后拇展肌和拇收肌的力学性质。取10个足标本，解剖后暴露拇展肌与拇收肌，将标本固定于电子万能试验机底座上，由钢丝绳吊钩沿拇收肌、拇展肌纵行方向钩住、钢丝绳上端固定于试验机上夹头上，驱动机器，对标本施加拉应力，直至拇收肌或拇展肌断裂，得出拉伸最大载荷、应力、应变等数据。对断裂后的拇收肌和拇展肌模拟临床手术进行移位吻接，10个拇展肌标本做了腱与腱移位吻接，另取10个拇收肌标本做了腱与腱吻接，10个拇收肌标本做了腱与骨膜吻接。分别对吻接后的标本进行拉伸实验，分别得出了吻接术后各组的拉伸最大载荷、应力、应变等数据和曲线。 以多项式，用最小二乘法得出了各组标本的应力-变关系表达式及应力应变曲线。实验结果表明，拇收肌的应力与拇展肌接近。拇收肌应变大于拇展肌。模拟临床手术拇展肌腱与腱吻合拉伸强度大于拇收肌腱与腱吻合。应变小于拇收肌腱与腱吻合，拇收肌移位腱与骨膜吻接强度低于腱与腱吻合，二者应变较接近。得出了一些重要结论。对实验结果进行分析讨论。     

拇展肌与拇收肌移位吻接术前、后黏弹性实验研究

研究了正常拇展肌、拇收肌拉伸黏弹性力学性质和模拟拇外翻拇展肌、拇收肌移位吻接术后拇展肌和拇收肌的拉伸黏弹性力学性质.取20个足标本,解剖后暴露拇展肌与拇收肌,得出拉伸应力松弛、蠕变等数据.对断裂后的拇收肌和拇展肌模拟临床手术进行移位吻接,对10个拇展肌和10个拇收肌标本做腱与腱吻接,另各取10个拇收肌、拇展肌标本做了腱与骨膜吻接.对吻接后的标本进行拉伸实验,得出了吻接术后各组拉伸应力松弛、蠕变曲线.以回归分析的方法处理实验数据,得出了归一化应力松弛、蠕变曲线及归一化应力松弛函数和归一换化蠕变函数.     

带血管蒂腓骨长肌腱转位修复跟腱缺损的临床应用

目的：报道带血管蒂腓骨长肌腱转位修复跟腱缺损的应用解剖、生物学力学和手术方法。方法：在４０侧动脉灌注红色乳胶的成人下肢标本上，对腓骨长肌腱进行显微解剖学观测及生物力学研究。在解剖学研究的基础上，设计并应用带血管腓骨长肌腱及皮瓣转位修复跟腱。结果：采用该术式修复跟腱及皮肤缺损９例。经１０个月～１．５年随访，移植的肌腱及皮瓣全部成活８例，愈合良好，跟腱功能恢复。１例皮瓣边缘性坏死，经短期换药愈合。结论：带血管蒂腓骨长肌腱和皮瓣转位是跟腱及皮肤缺损较理想的修复方法。     

Anatomical variations of the flexor hallucis longus muscle and the consequences for tendon transfer. A cadaver study

The aim of this study was to evaluate the occurrence of anatomical variations of the musculotendinous junction of the flexor hallucis longus muscle. Eighty cadaver specimens preserved according to Thiels method were assessed. Following careful dissection, the distance between the musculotendinous junction and the bone–cartilage border of the distal tibia was determined. Three typical anatomical variations were found: (1) a long lateral and shorter medial muscle belly; (2) equal-length medial and lateral muscle bellies; (3) a long medial and shorter lateral muscle belly. As a special variation in two cases only one lateral muscle belly was found. When planning a flexor hallucis longus transfer, preoperative magnetic resonance tomography (MRT) should be carried out in order to guarantee sufficient coverage of an existing soft tissue defect. These anatomical characteristics have also to be considered when interpreting ultrasonic or MRT findings in this region.     

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%).     

Intramuscular nerve distribution pattern of the oblique and transverse heads of the adductor hallucis muscles in the human foot

To understand which layer of the intrinsic muscles of the foot the adductor hallucis muscle belongs to, it is essential to investigate the innervation patterns of this muscle. In the present study, we examined the innervation patterns of the adductor hallucis muscles in 17 feet of 15 Japanese cadavers. We investigated the intramuscular nerve supplies of the adductor hallucis muscles in six feet and performed nerve fiber analysis in three feet. The results indicate that: (i) the oblique head of the adductor hallucis muscle is divided into three compartments (i.e. lateral, dorsal and medial parts) or two compartments (i.e. dorsal and medial parts) based on its intramuscular nerve supplies, but we could not classify the transverse head into any parts; (ii) the communicating twig between the lateral and medial plantar nerves penetrated the oblique head of the adductor hallucis muscle in 13 of 17 feet (76.5%); (iii) the penetrating twig entered between the lateral and dorsal parts of the oblique head, passed between the lateral and medial parts of this muscle and then connected with the medial plantar nerve; and (iv) the majority of the nerve fibers of the penetrating twig derived from the lateral plantar nerve. The present study demonstrated that only the lateral part of the oblique head of the adductor hallucis muscle had a unique innervating pattern different from other parts of this muscle, suggesting that the lateral part of the oblique head has a different origin from other parts of this muscle.     

跟腱复合组织缺损的显微外科修复

目的 :探讨跟腱复合组织缺损的显微外科治疗。方法 :应用膝降血管大收肌腱、骨、皮复合组织瓣移植一期修复跟腱伴皮肤和跟骨缺损。结果 :施术 3侧 ,取得满意效果。结论 :该术式可修复不同类型的跟腱复合组织缺损 ,并具有操作简便、易行和供区损伤小等特点。