带血管蒂腓骨移植的应用解剖与并发症的探讨

目的观察腓骨周围重要的血管及其分支的毗邻关系,为临床腓骨移植后出现的并发症提供解剖学依据,并说明腓骨移植手术应注意的问题。方法采用8例完整的成人下肢标本(其中男6侧,女2侧),对腓骨上、中、下三部分的骨膜营养动脉、滋养动脉及其周围重要动脉分别进行解剖观测。结果在腓骨上段,从腘动脉发出一支向腓骨头走行的分支,在腓骨头分出三支动脉,其中一支向下(直径0.161 cm)移行为腓骨上段骨膜营养动脉,另一支水平环绕,第三支(平均直径0.155 cm)向上平均走行1.75 cm,直接进入膝关节。在中段除主要的一支腓骨滋养动脉(直径0.210 cm)外,其余的细小的腓骨滋养动脉呈节段性进入腓骨,并且一般有腓动脉发出的腓骨膜营养动脉(主干直径为0.195 cm),距腓骨头9.05 cm向下分布中段大部分骨膜。在下段,上部有从腓动脉分出的2~3支弓状动脉(直径0.075 cm),绕过腓骨后,继续走行在肌肉之中,在下部距外踝4.50 cm处有腓动脉穿出后下降。结论临床上腓骨移植后出现的并发症与各段分布的动脉有密切的关系,保护好这些重要的血管有助于减少并发症的发生。

A study on the applied anatomy and complication of fibula transplantation with vascular

Objective To provide anatomical data to explain the clinical complications produced after vasculatized fibula grafts and put forth some suggestions to avoid those complications.Methods The whole length of fibula was divided into three portions.The nutrient artery,the nourish artery of the fibular periosteum around the fibular were dissected to measure and observe on the lower extremities of 8 cases(male 6 and female 2) which are preserved integrity.Results On superior segment of the fibular,one branch from the popliteal artery moving towards the capitulum branched out three arteries.One of them run downwards(diameter of 0.161 cm) and turned to nourish artery of the fibular periosteum.The second branch hooked the fibula horizontally and run backwards.The third(diameter of 0.155 cm) went upwards with the length of 1.75 cm averagely,then entered the knee joint directly.In the middle segment,tiny nutrient arteries of fibula entered the fibula regularly besides the main nutrient artery(diameter of 0.210 cm) of fibula.Generally,there is an artery to fibular periosteum(diameter of 0.195 cm) came from the fibular artery.In the lower segment,there are 2-3 arcuate arteries originated from the fibula artery(diameter of 0.075 cm) to supply the muscles located lateral to the fibula.Conclusion Taking place of complications after the vacularized fibula graft had close relationship with the distribution of arteries around fibula,Protection of the those arteries will contribute great deal to the reduction of complications occurrence.