桡动脉与足背动脉的解剖学特点及其临床意义

目的研究桡动脉和足背动脉的直径及管壁厚度,为桡动脉和足背动脉置管以及经桡动脉冠状动脉造影等提供解剖学依据。方法用体视显微镜测量31具尸体62侧桡动脉远侧段和60侧足背动脉的内径(ID)及外径(ED)。结果①桡动脉平桡骨茎突上5cm处断面(SARA)的外径、内径和管壁厚度(WT)分别为(2.33±0.49)mm、(1.31±0.45)mm和(0.51±0.13)mm,与平桡骨茎突处断面(SBRA)比较,SARA小于SBRA(P<0.05)。②足背动脉中点断面(SMDPA)的外径、内径和管壁厚度分别为(2.47±0.49)mm、(1.28±0.50)mm和(0.60±0.16)mm。与近端和远端比较,3组均数差异均有统计学意义。③桡动脉远侧段与足背动脉的内、外径及管壁厚度无侧别差异,但有年龄和性别差异,50岁以上组大于中、青年组,男性管壁厚度大于女性。④SARA和SMDPA的内、外径和管壁厚度有正相关关系。结论:本研究结果对桡动脉和足背动脉穿刺置管术的开展与应用等具有参考价值。     

膝下外侧动脉远端蒂腓骨头瓣的应用解剖

目的为膝下外侧动脉远端蒂腓骨头瓣移植提供解剖学基础。方法在30侧经动脉内灌注红色乳胶成人下肢标本上重点观测膝下外侧动脉发出腓骨头支近端及远端的长度及外径,另在1侧新鲜标本上进行摹拟手术设计。结果膝下外侧动脉始于腘动脉,近端长(4.1±0.5)cm,外径(1.8±0.2)mm,远端长为(5.3±0.4)cm,外径为(1.0±0.1)mm。结论以膝下外侧动脉远端为蒂的腓骨头瓣,较近端为蒂损伤小、操作简便等优点。     

足背、胫前动脉移植—冠状动脉旁路术的应用解剖

目的 :为足背、胫前动脉用于冠状动脉旁路移植术提供解剖学基础。方法 :成人尸体下肢材料44侧 ,对足背动脉和胫前动脉下段进行了解剖观察和测量。结果 :胫前动脉下段和足背动脉上、中、下点的外径分别为 :(2 .5± 0 .6)mm ;(2 .3± 0 .4)mm ;(1.9± 0 .4)mm。胫前动脉下段至足背动脉末端的长度为(18.10± 0 .6)cm。结论 :胫前动脉下段和足背动脉位置浅表 ,联合截取有足够的长度和较适宜的管径 ,可作为冠状动脉旁路移植术的供体材料。     

足背内侧皮神经营养血管皮瓣修复足远端创面应用解剖

目的：为远端蒂足背内侧皮伸经浅静脉营养血管皮瓣修复足远端皮肤缺损提供解剖学基础。方法：在31侧成人下肢标本f：解削观察足背内侧皮神经分支分布特点，6侧新鲜足标本观测皮神经血供分规律。结果：足背内侧皮神经及其分支恒定的血供来源，近端主要来自胫前动脉末端或足背动脉发m的皮支，外径0．8～1．0mm，内、外侧支远端来自南足底内侧动脉的皮支和第2跖背动脉末端的皮支，皮动脉外径在0.5—0．8mm。皮动脉分支营养神经及神经及浅静脉，在神经和静脉旁分支间形成链式吻合，与筋膜皮肤的血管互相吻合。结论：足背内侧皮神经浅静脉营养血管足背皮瓣可设计两种远端蒂修复足远端创面，(1)以第1跖趾关节内侧近端1．3～1．5cm为旋转轴点。(2)以距第2趾蹼游离缘1．5cm为旋转轴点。     

国人足背动脉解剖与临床研究进展

目的：了解国人足背动脉的解剖学与临床研究进展,为临床应用提供参考。方法：通过检索和查阅相关文献,总结分析有关足背动脉与长伸肌腱及腓深神经的位置关系及形态学的资料。结果：①足背动脉的体表投影在内、外髁连线前方中点至第1跖骨间隙近侧端的连线。②主要根据其走行与外径足背动脉可分为4、5、63种类型;③足背动脉位腓深神经内侧者占36．1％;位腓深神经内侧终末支内侧者占50％;位腓深神经外侧者占23．5％。结论：了解国人足背动脉的解剖学特点,可为临床应用提供足背动脉相关的解剖学资料。     

足背、胫前动脉移植一冠状动脉旁路术的应用解剖

目的为足背、胫前动脉用于冠状动脉旁路移植术提供解剖学基础.方法成人尸体下肢材料44侧,对足背动脉和胫前动脉下段进行了解剖观察和测量.结果胫前动脉下段和足背动脉上、中、下点的外径分别为(2.5±0.6)mm;(2.3±0.4)mm;(1.9±0.4)mlml.胫前动脉下段至足背动脉末端的长度为(18.10±0.6)cm.结论胫前动脉下段和足背动脉位置浅表,联合截取有足够的长度和较适宜的管径,可作为冠状动脉旁路移植术的供体材料.     

腓深神经和足背动脉关系在足背复合组织瓣中的意义

目的:探讨腓深神经和足背动脉在足背部的位置关系,为带神经血管蒂的足背复合组织瓣的切取提供解剖基础。方法:选用经福尔马林固定的足踝部完好的下肢68侧,逐层解剖,在踝上显露腓深神经和胫前动脉向远端追踪解剖;定量描述腓深神经分支点到足背动脉和踝间线的位置关系,并对神经和动脉的位置关系进行分型。结果:腓深神经分支点集中在踝间线上(9.34±3.4)mm至踝间线下(14.00±5.28)mm;动脉内侧3.46mm至动脉外侧3.32mm这个范围之内,58.0%(36侧)位于动脉的前上。神经分支后,外侧支位于浅面,与深面的跗外侧动脉平行进入短伸肌;内侧支与动脉伴行,根据神经与动脉关系可分为5型:Ⅰ型,神经伴行于动脉的内侧(50.0%);Ⅱ型,神经位于动脉的外侧(11.8%);Ⅲ型,神经和动脉彼此交叉(26.5%);Ⅳ型,动脉自神经内侧支的分支间穿出(2.9%);Ⅴ型:内侧支缺如(8.8%)。结论:腓深神经和足背动脉在足背部位置关系的解剖特点对足背复合组织皮瓣的切取有指导意义。     

桡动脉远侧段的解剖学特性及其临床意义

目的为桡动脉置管和经桡动脉冠状动脉造影的临床应用提供解剖学依据.方法用体视显微镜测量31具尸体共62侧桡动脉远侧段的内径(ID))、外径(ED).结果(1)桡动脉平桡骨茎突上5cm处断面(SA)ED、ID和管壁厚度(WT)分别为(2.33±0.49)mm、(1.31±0.45)mm和(0.51±0.13)mm.(2)桡动脉平桡骨茎突处断面(SB)ED、ID和WT分别是(2.71±0.45)mm、(1.52±0.54)mm和(0.59±0.16)mm,三者均大于SA(P＜0.05).(3)桡动脉的ID、ED及WT存在性别和年龄的差异(P＜0.05),但无侧别差异(P＞0.05).结论本文结果对桡动脉穿刺置管和经桡动脉冠状动脉造影术等具有应用价值.     

旋肩胛动脉双叶皮瓣修复手足皮肤软组织缺损的解剖学研究

目的:为临床应用旋肩胛动脉双叶皮瓣修复手足皮肤软组织缺损时,确定皮瓣的最大切取面积提供解剖学基础.方法:用30侧成人肩胛区标本,对旋肩胛动脉及其皮支、吻合支的起始、走行、分布等进行了详细的解剖观察和测量.结果:旋肩胛动脉起始处外径为(3.1±0.5)mm,自主干发出升支、横支和降支.升支起始处外径约(0.7±0.1)mm,发出后斜向外上跨肩胛冈至冈上窝;横支起始处外径(1.1±0.1)mm,发出后自肩胛冈下约2 cm跨越肩胛骨内上行,动脉长(65.5±8.5)mm;降支起始处外径(0.9±0.1)mm,发出后沿肩胛骨腋缘指向肩胛下角斜向下行,动脉长(47.3±7.3)mm.结论:旋肩胛动脉双叶皮瓣的解剖学研究对手足皮肤软组织缺损的修复具有临床指导意义.     

上颌动脉第2、3段交界处主要分支的应用解剖

目的研究上颌动脉第2、3段交界处主要分支的走行及规律,为该部位的动脉结扎、肿瘤切除和颅面外科手术提供解剖学资料。方法采用颞下入路解剖28具成人尸头,观测上颌动脉第2、3段交界处主要分支的起始、走行、外径、长度和毗邻关系。结果上颌动脉第2、3段交界处主要分支有颞深前动脉、上牙槽后动脉和眶下动脉,主干及分支起始、走行变异常见。上颌动脉第2段走行于翼外肌浅面的有52侧(92.86%),走行于深面的有4侧(7.14%),外径为(2.46±0.42)mm;颞深前动脉共干外径为(1.47±0.42)mm,长度为(7.67±2.62)mm,单干外径为(1.16±0.34)mm,颞深前-上牙槽后动脉起始处间距为(7.01±2.65)mm;上牙槽后动脉共干外径为(1.93±0.32)mm,长度为(4.81±2.44)mm,单干外径为(1.75±0.42)mm,长度为(8.40±3.29)mm;眶下动脉外径为(1.52±0.30)mm,长度为(8.46±2.29)mm,眶下-上牙槽后动脉起始处间距为(7.20±3.88)mm。结论熟悉上颌动脉第2、3段交界处主要分支的解剖学资料对指导该部位手术,降低术后并发症具有重要意义。     

Anatomy of dorsalis pedis artery and its use in limb salvage surgery

The Dorsalis Pedis artery (DPA) is an often overlooked but important artery that can be utilized for limb salvage surgery. It is especially useful in the diabetic patient in whom disease at the level of the bifurcation of the popliteal artery is common. The unique anatomic location and communication with the pedal arch makes the DPA a good outflow vessel. Surg. Gynecol. Obstet. 105:401–405 (Verta, 1982, Ascer, 1988 J. Vasc. Surg., 8:434–441; Harris, 1989, Arch Surg., 124:1232–1235). © 1992 Wiley-Liss, Inc.     

Vascular anomalies in campomelic syndrome

We report on 4 patients with the campomelic syndrome (CS) in whom postmortem angiography of the lower limbs was performed. Of the 4 ptients, 3 were phenotypic females (2 of them with a 46,XY karyotype) and one was a male with a normal 46,XY karyotype. Three fulfilled the criteria fo CS, and one (phenotypically female with a 46,XY karyotype) lacked the lower limb bowing and the talipes equinovarus typical of CS. This infant may constitute a further example of the recently reported CS without campomelia. The results of the angiographic study are compared with 46 postmortem angiographies of normal fetuses and newborn infants at different gestational ages. In the first 3 Cs patients the main arterial axis of the lower limb, formed by the superficial femoral and anterior tibial arteries, has smaller diameters than expected while the profunda femoris and posterior tibial arteries had greater diameters than age-matched controls However, the most striking abnormality was the absence or marked deficiency of the anterior tibial artery. Its terminal branch, the doralis pedis artery, was also absent and the plantar arch was abnormally formed by the posterior tibial artery either alone or in conjunction with the peroneal artery. The normal arterial pattern was found in the patient who lacked bowed bones. This finding supports an developmental association between vascular defects and lower limb anomalies in CS. This aberrant arterial pattern in CS may affect or be affected by muscle development. The shortness of the posterior femoral and calf muscles fix the knee and the ankle joints. Bone bowing is probably related to the abnormal mechanical forces applied to the developing long bones of the lowe limb. © 1993 Wiley-Liss, Inc.     

足背深浅静脉交通支的瓣膜朝向与皮瓣移植的关系

解剖研究了30例成人下肢标本的足背浅静脉与深静脉间的交通支,重点观察了这些交通支内瓣膜存缺情况及其朝向。这些交通支的静脉瓣可以分为三类:第一型的静脉瓣膜朝向引导血流由浅入深,第二型则引导血流由深至浅,第三型静脉交通支内没有瓣膜。足背皮瓣移植术中,沟通深浅两套静脉系统的关键性交通支是浅弓支。浅弓支属第三型,其出现率占70%,这是大多数足背皮瓣移植时只吻合浅静脉或深静脉均能引导血液回流,保证皮瓣成活的解剖学基础。但对30%缺乏浅弓支的个体,手术时必须同时吻合浅深两套静脉,才能保证回流通畅。     

Relationship between the deep peroneal nerve and dorsalis pedis artery in the foot: a cadaveric study

The aim of our work was to study the relationship between deep peroneal nerve (DPN) and dorsalis pedis artery (DPA) so that the frequency of these variations can be kept in mind by the angiographers and surgeons to ensure safe surgical approach during flap surgery. Ninety-two legs in 46 cadavers were dissected to study the relationship between DPN and DPA on the dorsum of the foot. The relationship of neurovascular bundle of the dorsum of the foot was classified into four types. Type I: division of the DPN distal to the midpoint between the two malleoli (observed in 26 limbs). In Type II, the division of the DPN was midway between the two malleoli (seen in 20 limbs). Both Type I and II are further divided into two subtypes (a and b) depending upon the crossing pattern of terminal branches of the DPN over DPA. In Type III, multiple branches of DPN were noted in two limbs. In Type IV, the looping pattern of DPN around the DPA was considered and was seen in eight limbs. Awareness of possible variations in the relationship of the DPA to DPN on the dorsum of the foot is important for vascular and reconstructive surgeons. Because it might help in decreasing confusion when considering treatment options like microvascular anastomosis in reconstruction of the leg.     

足背多叶皮瓣的临床应用

目的探讨足背多叶皮瓣的临床应用价值。方法根据足背动脉在足背部发出分支的解剖特点,将足背皮瓣设计成两叶或三叶形状,同时修复2个或2个以上互不相连的创面。1998年1月至2004年5月,临床应用12例,局部转移修复同侧足部创面3例,游离移植修复手部创面9例。结果皮瓣全部成活。有8例获得随访7-24个月,外形满意。两点分辨觉6-9mm.。结论根据足背动脉在足背部发出分支的解剖特点,将足背皮瓣设计成2叶或3叶,一次修复多个互不相连的创面。皮瓣血供可靠,手术简便、实用,足背是修复多创面软组织缺损的良好供区。     

探讨VSD负压封闭引流后延期皮瓣移植术的临床疗效

目的探讨清创后VSD负压封闭引流后延期行腓肠神经、小隐静脉远端蒂筋膜皮瓣移植术的临床疗效。方法选择2007年6月～2011年10月足部皮肤软组织缺损行腓肠神经、小隐静脉远端蒂筋膜皮瓣移植术病例37例,采用急诊清创后即行皮瓣移植18例为对照组;采用急诊清创、VSD负压封闭引流后延期行皮瓣移植19例为观察组,术后随访观察患者的并发感染情况,皮瓣成活情况以及术后患者功能恢复优良程度。结果两组抗感染能力、皮瓣成活率、功能恢复优良率差异有统计学意义（P〈0．05）。结论采用VSD技术加延期腓肠神经、小隐静脉远端蒂筋膜皮瓣移植术修复足部皮肤软组织缺损,可以大大降低足部皮肤软组织缺损的感染的发生率,并提高了皮瓣的成活率,改善了患者的患肢功能。     

带足背内侧皮神经及其营养血管筋膜皮瓣的应用解剖学

目的：为带足背内侧皮神经及其营养血管筋膜皮瓣提供形态学基础。方法：在３２侧成人下肢标本上，观测了踝间线以下足背内侧皮神经营养血管及其周围皮肤的血供情况。结果：足背内侧皮神经的血供主要来自足背动脉的皮动脉，以其近侧端（上支持带下缘）和远侧端（第１跖骨间隙）穿出的皮动脉较为恒定，起始处外径分别为０．８ｍｍ和０．６ｍｍ，穿出深筋膜前长分别为０．８ｃｍ和０．５ｃｍ。皮动脉的神经营养支在神经束间或神经旁则相互联通形成纵形（或链式）吻合，而皮动脉的皮支和神经营养支在足背内侧皮神经周围的浅筋膜内也相互沟通形成广泛的网状吻合。结论：可设计带皮神经及其营养血管筋膜皮瓣转位修复邻近部位的组织缺损     

Perfusion through the dorsalis pedis artery for acute limb ischemia secondary to an occlusive arterial cannula during percutaneous cardiopulmonary support

Percutaneous cardiopulmonary support (PCPS) is a powerful resuscitation tool for patients in cardiogenic shock. The femoral artery is generally used for arterial access; however, vascular complications, particularly in atherosclerotic arteries, can occur. Although such complications occur infrequently, they can be fatal. We describe the case of a 75-year-old woman who required extended PCPS for cardiogenic shock secondary to coronary spasm after on-pump beating coronary artery bypass grafting. Limb ischemia occurred because of an occlusive cannula, and distal perfusion with a 20G elastic intravenous catheter inserted into the dorsalis pedis artery resolved the ischemia. The catheter was connected to the side port of an oxygenator and provided distal limb perfusion during PCPS. This technique appears to be useful in treating limb ischemia and may have application in patients with arterial occlusive disease who are dependent on mechanical support.