颈横血管肩胛冈支骨瓣移位修复下颌骨缺损的应用解剖

目的为下颌骨缺损提供带血管蒂骨瓣移位修复术的应用解剖学基础。方法在１５具（３０侧）灌注红色乳胶的成人尸体标本上，观测颈横血管及其肩胛冈支的走行、分支及分布。结果颈横动脉全程分为：颈段，长（４．７±０．１）ｃｍ，起始外径（４．０±０．１）ｍｍ；背段，长（５．８８±０．６３）ｃｍ，起始外径（３．３０±０．３５）ｍｍ。颈横动脉肩胛冈支８６．７％起于颈横动脉浅支，１３．３％起自颈横动脉，干长（４．９７±１．６８）ｃｍ，起始外径（２．０８±０．２７）ｍｍ。肩胛冈支恒定地向肩胛冈发出４～８支骨膜支营养肩胛冈。结论颈横血管肩胛冈支是肩胛冈区的主要血供来源之一，以其为蒂的肩胛冈骨瓣可以颈横血管背段起始处为旋转点向下颌区移位，血管蒂平均长约１０．８５ｃｍ，可为下颌骨缺损修复提供一种新的术式。

APPLIED ANATOMY OF BONE FLAP PEDICLED WITH SPINA SCAPU LAR BRANCH OF TRANSVERSE CERVICAL ARTERY FOR MANDIBULAR RECONSTRUCTION

OBJECTIVE: To study the anatomical basis of vascularized spina scapular bone flap, which was used in mandibular reconstruction. METHODS: Fifteen adult cadavers were adopted in this study. The two common carotid arteries of each cadaver were intubed and perfused with red emulsion respectively. Then the course and distribution of the transverse cervical artery(TCA) and its spina scapular branches were observed on 30 sides. RESULTS: The TCA was divided into two segments: the cervical segment originated from the origin of the artery to the superior margin of the trapezius muscle, and the dorsal segment originated from the superior margin of the trapezius muscle to the site where the TCA bifurcated into the superficial and deep branches. The average length and original caliber of the cervical segment were(4.7 +/- 0.1) cm and (4.0 +/- 0.1) mm. The average length and original caliber of the dorsal segment were (5.88 +/- 0.63) cm and (3.30 +/- 0.35) mm. 86.7% spina scapular branches originated from the superficial branch of TCA and 13.3% from TCA. The length of the spina scapular branch was (4.97 +/- 1.68) cm and its external diameter was (2.08 +/- 0.27) mm. It constantly sent 4-8 periosteal branches to spina with 0.20-1.25 mm in caliber. CONCLUSION: The spina scapular branch of TCA is one of the main blood supplier to the spina scapular area. The spina scapular flap pedicled with spina scapular branch of TCA may provide a new operation for mandibular reconstruction, whose circumpoint locates at the origin of the dorsal segment and the average length of the pedicle is 10.85 cm which enough to transposite to mandibular area.