带血管蒂肱骨中段骨膜瓣移位术的应用解剖

目的 :为带血管蒂肱骨中段骨膜瓣移位术提供解剖学依据。方法 :在 3 8侧经动脉灌注红色乳胶的成人尸体上肢标本上对肱骨中段前内侧面和部分前外侧面骨膜血管的来源、走行、分支、分布及吻合进行观测 ,并在 4侧标本上摹拟手术实验。结果 :旋肱前动脉主干行经喙肱肌和肱二头肌短头深面 ,绕肱骨外科颈外进至结节间沟外侧缘处分出升支和降支 ,升支上行分布于肱骨头及小结节部 ,降支有 2条分别沿胸大肌止腱内、外侧紧贴骨膜下行 ,为内侧降支和外侧降支。肱动脉肌间隙支自肱动脉发出后向外上走行至三角肌止端内侧发一升支即直接骨膜支上行连接旋肱前动脉的内侧降支。结论 :以旋肱前动脉内侧降支和肱动脉肌间隙支为蒂的肱骨中段骨膜瓣移位可用于修复肱骨头缺血性坏死和肱骨上、中段骨不连、骨缺损。

Applied anatomy for the transposition of the pedicled middle humerus periosteal flap basis and clinical significance

To provide anatomic basis for the transposition of the pedicled middle humerus periosteal flap.Methods:The origin,course,branches and anastomosis of the periosteal vessels for anteromedial and anterolateral part of the middle humerus were observed on 38 adult upper limb cadaver specimens.Results:The anterior humerus circumflex artery sends one ascending branch and two descending branches at the lateral edge of the intertubercular groove around the surgical neck of humerus.The descending branches runs downward closely to the periosteal along the medial and lateral insertion of the major pectoral muscle,namely there is a medial descending branch and a lateral descending branch.The intermuscular septum branch of the humeral artery goes superiolaterally to the medial insertion of the deltoid muscle and sends a ascending branch,the direct periosteal branch,to anastomosis the medial descending branch upwards.Conclusions:The transposition of the middle humerus periosteal flap pedicled with the medial descending branch of the anterior humeral circumflex artery and the intermuscular septum branch could be designed to repair the avascular necrosis of the humeral head or the defects of the upper middle humerus.