跟外侧动脉的显微外科解剖

目的探讨跟外侧动脉的起始、行程、分支和分布等情况,为临床实践提供解剖学资料。方法在12侧经股动脉灌注红色乳胶溶液的成人下肢标本上,对跟外侧动脉进行显微外科解剖,观察其出现率并测量其起始位置、起始处及穿深筋膜处的口径。以外踝尖为基点,对外踝尖上6 cm范围内每2 cm间隔内跟外侧动脉分支的蒂长和口径进行测量并作统计学分析。另取小腿动脉血管造影标本5例,进一步观察跟外侧动脉行程及其与跟腱表面皮瓣血供的关系。结果跟外侧动脉于外踝尖上4.9～9.4(6.56±1.30)]cm处源自腓动脉,起始处口径为1.0～3.3(1.78±0.60)mm,穿深筋膜处口径为0.44～2.0(0.81±0.40)mm。其全程呈"L"型,垂直段共有2～5(2.50±0.80)支分支。在外踝尖上0.00～2.00、2.01～4.00、4.01～6.00 cm间隔内,分支的蒂长和口径分别是:(0.81±0.31)、(1.68±0.55)、(1.59±0.41)cm和(0.80±0.31)、(0.80±0.11)、(0.85±0.23)mm。垂直段分支分支纵、橫穿行,纵者吻合成链状与腓肠神经及小隐静脉伴行,参与腓肠神经营养血管皮瓣供血系统的组成,橫行者越过跟腱浅面与来自胫后动脉的分支吻合,供养跟腱区皮瓣;水平段分支3～5支,分布于足外侧面后侧约1/3皮肤软组织。结论跟外侧动脉是腓动脉的直接延续,尸体标本和活体标本中跟外侧动脉出现率分别为100%和80%;跟外侧动脉既参与腓肠神经营养血管皮瓣供血系统的组成,又营养跟腱表面的皮瓣。

Microsurgical study on the lateral calcaneal artery

Objective To investigate the origin,course,and distribution of the lateral calcaneal artery and provide anatomical basis for surgical practice.Methods The study was performed on 12 cadaver legs and feet specimens perfused with red latex(10 were formalin-preserved and 2 were fresh) and 5 lower extremity arteriograms.The original position and the outer diameters at the point where the artery originated from the peroneal artery and pierced through the deep fascia were measured.Cluster analysis was carried out to study both the branches’ pedicle length and outer diameter at different 2-cm interval within the Achilles tendon area.Five lower extremity arteriograms of 5 volunteers were then used to observe further the distribution of the artery.Results The lateral calcaneal artery originated from the peroneal artery at 4.9-9.4(6.56±1.30) cm above the tip of the lateral malleolus then went tortuously downwards to the lateral side of the foot,with 1.0-3.3(1.78±0.60)mm at its original point and 0.44-2.0(0.81±0.40) mm at the exit point where it pierced through the deep fascia in outer diameter.Within the intervals of 0.00-2.00,2.01-4.00,4.01-6.00 cm,the pedicle lengths and outer diameters were(0.81±0.31)cm,(1.68±0.55) cm and(1.59±0.41) cm,and 0.80±0.31 mm,(0.80±0.11) mm and(0.85±0.23) mm,respectively.Perforators from the lateral calcaneal artery took either a longwise or a transverse course to respectively nourish the sural fasciocutaneous flap or the fasciocutaleous flap overlying the Achilles tendon.Conclusion The lateral calcaneal artery is the terminal branch of the peroneal artery in all of 12 cadaver specimens and 4 out of 5 volunteers.The lateral calcaneal artery gives off branches to contribute the vascularity of both the sural fasciocutaneous flap and the fasciocutaleous flap overlying the Achilles tendon.