股内侧肌穿支蒂股中间皮神经营养血管皮瓣的应用解剖

目的为股内侧肌穿支蒂股中间皮神经营养血管皮瓣提供解剖学基础。方法在30侧动脉内灌注红色乳胶的成人下肢标本上,以髌骨中点、收肌结节为观测标志解剖观测:①股中间皮神经走行与分布;②股内侧肌穿支与股中间皮神经营养血管间的吻合关系。另用1侧新鲜标本进行摹拟手术。结果①股中间皮神经前支体表投影相当于腹股沟韧带中点与髌结连线(髌骨中点至收肌结节的连线)中点的连线;②股内侧肌穿支穿出点位于股内侧肌支体表投影线(腹股沟中点与收肌结节连线中、下1/3交界点至髌骨中点的表线)中点附近,相当于收肌结节上(9.4±2.4)cm、髌骨中点垂线内(4.1±1.0)cm处。穿支穿过深筋膜至皮下,并分出众多的细小血管与股中间皮神经的神经旁和神经干血管链(网)密切吻合,在大腿前内侧形成顺沿股中间皮神经纵轴的血管丛。结论可形成股内侧肌穿支蒂股中间皮神经营养血管皮瓣转位修复膝部软组织缺损术式。

Applied anatomy of intermediate femoral neurocutaneous flap pedicled with the vastus medialis perforators

Objective　To provide anatomic basis for the intermediate femoral neurocutaneous flap pedicled with the vastus medialis perforators.　Methods　30 embalmed lower limb specimens from adult cadavers perfused with red latex were used for this anatomical study. The midpoint of patella and adductor tubercle were used as observation points, for the following exploration: ①The course and distribution of the intermediate femoral cutaneous nerve；②Anastomosis between the vastus medialis perforators and the nutrient vessels of the intermediate femoral cutaneous nerve. Simulated operation was performed on one side of fresh specimen.　Results　①The line between the midpoint of inguinal ligament and the midpoint of the patella-adductor tubercle line which between the midpoint of the patella and adductor tubercle can be considered as the projection on body surface of the anterior branch of intermedial femoral cutaneous nerve. ②The location of vastus medialis perforators was nearly at the midpoint of the line between the midpoint of patella and the one thirds of the line between the midpoint of inguinal ligament and the adductor tendon, about (9.4±2.4)cm above the adductor tendon and (4.1±1.0)cm interiorly of the inner of the vertical line of the middle patella. The vastus medials perforators pierced through the deep fascia and gave off large number of small blood vessels, which closely aligned with the nutrient vessels of intermediate cutaneous nerve, and then formed vascular plexus in the anteromedial part of thigh along the intermediate femoral cutaneous nerve.　Conclusions　The intermediate femoral neurocutaneous flap pedicled with vastus medialis perforators can be developed to repair soft tissue defects around knee joint.