展肌上缘动脉弓的分型及其临床意义

目的　对 展肌上缘动脉弓的形成进行分型，为以　展肌上缘动脉弓为蒂逆行足底内侧皮瓣的临床应用提供解剖学基础。 方法 在81例足动脉铸型标本和2只动脉灌注红色乳胶成人新鲜下肢标本上观察　展肌上缘动脉弓的形成、走形与分布。 结果　根据　展肌上缘动脉弓的形成将其分为3型：Ⅰ型.内踝前动脉与跗内侧动脉型：主要由内踝前动脉、跗内侧动脉及其分支形成，占22.9%（19例）。Ⅱ型.足底内侧动脉浅支型：主要由足底内侧动脉浅支及其分支形成，占3.6%（3例）。Ⅲ型.混合型：由足底内侧动脉浅支与内踝前动脉、跗内侧动脉及其分支相互吻合形成。根据吻合形式的不同，又将其分为两个亚型，Ⅲ1型.直接吻合型：内踝前动脉、跗内侧动脉发出后直接与足底内侧动脉浅支及其分支吻合形成，占48.2%（40例）；Ⅲ2型.间接吻合型：内踝前动脉、跗内侧动脉发出后与足底内侧动脉浅支及其分支相互吻合成环形，占24.1%（20例）。 结论　根据　展肌上缘动脉弓形成的不同分为内踝前动脉与跗内侧动脉型、足底内侧动脉浅支型和混合型。其中混合型又分为直接吻合型和间接吻合型两种亚型。

The grouping and clinical significance of arterial arch at the superior bonier of the halluical abductor

Objective To group arteries of arterial arch at the superior border of the hallucal abductor according to their constitutes and provide anatomical basis for reverse bifolicated flap based on it.　Methods　The constitute, track-way and distribution of arterial arch at the superior border of the hallucal abductor were observed and analyzed on 81 lower limbs cast specimens and 2 fresh feet specimens perfused with red latex. Results　According to their constitute , arterial arch can be classified into 3 types: ①typeⅠ, constituted mainly by the branch of anterior medial malleolus artery and/or the medial tarsal artery, with the occurrence rate of 22.9% (19 case); ②typeⅡ, constituted mainly by the superficial branch of the medial plantar artery, with the occurrence rate of 3.6%(3 case); ③type Ⅲ, constituted mainly by the superficial branch of the medial plantar artery anastomosed with the branch of anterior medial malleolus artery and the branch of medial tarsal artery, which can be further divided into 2 subtypes according to the different anastomosis of the artery: directly and indirectly. The direct type was about 48.2% (40 case), with the forming of arterial arch from the anterior medial malleolus artery and/or the medial tarsal artery anastomosed directly with the superficial branch of the medial plantar artery. The indirect type was about 24.1%(20 case), with the forming of the arterial arch from the arterial circle ,which anastomosed by the branch of anterior medial malleolus artery, the branch of medial tarsal artery and the superficial branch of the medial plantar artery.　Conclusions　Arterial arch at the superior border of the hallucal abductor can be classified into 3 types: The type of anterior medial malleolus and medial tarsal arteries, the type of superficial branch of the medial plantar artery, and the type of the mixed. Furthermore, mixed one can be subclassified to the direct and indirect types according to the different anastomosis of arteries.