摘要
目的:探讨前臂皮神经-浅静脉营养血管远端蒂复合瓣的构建,为临床手部损伤修复提供解剖学理论。方法:实验于2003-12/2004-12在南京军区福州总医院军区临床解剖学研究中心实验室完成。94侧动脉灌注红色乳胶成人上肢标本(由南京军区福州总医院军区临床解剖学研究中心提供)。取90侧标本解剖观测前臂皮神经-浅静脉下1/3段营养血管的来源、分支、吻合及其与尺、桡骨血供关系:①前臂皮神经-浅静脉营养血管的来源、分支及吻合。②前臂皮神经-浅静脉营养血管与桡骨、尺骨骨膜血供的关系。另用4侧标本行远端蒂复合瓣摸拟手术设计。结果:取90侧成人上肢标本进入结果分析。前臂皮神经-浅静脉下1/3段为多源性供血,①前臂外侧皮神经-头静脉的营养血管来自桡动脉穿皮支6～11支,掌浅支穿皮支2～6支,桡骨茎突返支穿皮支一两支,鼻烟壶穿皮支一两支。桡动脉肌间隙骨皮穿支1～3支分布桡骨体部中下段的裸露区。②前臂内侧皮神经-贵要静脉的营养血管来自尺动脉穿皮支5～9支。骨间前动脉和骨间后动脉发骨皮穿支两三支与1～3支,分布尺骨中下段骨膜。③前臂后皮神经营养血管来自桡侧副动脉穿皮支2～6支,骨间后动脉尺侧骨穿皮支1～3支,桡侧骨穿皮支一两支,骨间前动脉腕背支穿皮支3～5支。骨间后动脉发肌骨膜6～8支,分布尺骨中上段背侧骨膜。上述穿皮支平均外径在0.5～0.8mm,发皮支、筋膜支、皮神经-浅静脉营养血管,形成皮神经-浅静脉血管链以及深、浅筋膜血管网。结论:前臂下1/3段的皮神经、浅静脉、骨膜、筋膜和皮肤的营养血管同源,可以设计3种皮神经-浅静脉营养血管远端蒂复合瓣,旋转轴点在腕关节平面,可用于手部创伤修复。
AIM： To investigate the construction of compound flap of distal pedicle with nutrient vessel of cutaneous nerve of forearm and superficial vein, so as to provide anatomic theory for repairing hand injury in clinic.
METHODS： The experiment was carried out in the laboratory of the Research Center of Clinical Anatomy, Fuzhou General Military Hospital of Nanjing Military Area Command of Chinese PLA between December 2003 and December 2004. The upper limb specimens perfused with red gelatin of 94 adult samples were provided by the Research Center of Clinical Anatomy, Fuzhou General Military Hospital of Nanjing Military Area Command of Chinese PLA, 90 samples were dissected to observe the origins, branches and inosculations of 1/3 inferior segment of nutrient vessel of cutaneous nerve of forearm and superficial vein and its relationship with the blood supply of ulnar and radius. The mimic operation of compound flap of distal pedicle was designed on the other 4 samples.
RESULTS： All the 90 upper limb specimens were involved in the analysis of results. The 1/3 inferior segment of cutaneous nerve of forearm and superficial vein had multi-sources blood supply. ① The origins of nutrient vessel of lateral antebrachial cutaneous nerve- cephalic vein were as follows： radial artery cutaneous branches 6-11 branches, cutaneous branches of superficial palmar branch 2-6 branches, malleolus radialis recurrent branch cutaneous branches 1-2 branches, tabatiere anatomique cutaneous branches 1-2 branches. Osteal cutaneous branches of spatium intermusculare of radial artery 1-3 branches were distributed on the naked area of the middle and lower segment of radius. ② The origin of nutritional vessels of cutaneous antebrachii medialis nerve and basilic vein of forearm was the perforating branches of ulnar artery （5-9） branches. Anterior interosseous artery and posterior interosseous artery formed osteal cutaneous branches 2-3 branches and 1-3 branches, which were distributed on periosteum of middle and lower segment of ulnar bone. ③ The origins of nutrient vessel of posterior antebrachial cutaneous nerve was as follows： radial collateral artery cutaneous branches 2-6 branches, osteal cutaneous branches of ulnaris of posterior interosseous artery 1-3 branches,osteal cutaneous branches of radialis 1-2 branches, dorsal carpal cutaneous branches of interior interosseous artery 3-5 branches. Posterior interosseous artery formed muscle and periosteum branches 6-8 branches, which were distributed on dorsi-periosteum of middle and upper segment of ulnar bone. Above mentioned cutaneous branches＇ external diameter were 0.5-0.8 ram, which originated from cutaneous branches, fascia branches, periosteum branches,nerve- superficial vein nutrition vessel and form cutaneous nerve - cephalic vein vessel chain and deep and superficial fascia and periosteum rete vasculosum.
CONCLUSION; The nutrient vessel of cutaneous nerve and cephalic vein and periosteum and fascia of 1/3 inferior segment of forearm and muscle, bone, skin nutrient vessels have homology. The distally based compound flap pedicle which adopted recurrent branch of malleolus radialis as stem with the rotation point at the wrist joint can be applied to repair soft tissues defect of distant part of hand.
出处
《中国临床康复》
CSCD
北大核心
2005年第46期79-82,T0004,共5页
Chinese Journal of Clinical Rehabilitation
基金
福建省自然科学基金资助项目(C0510034)~~
作者简介
张发惠，男，1948年生，福建闽侯县人，汉族，1985年福州军区军医学校毕业，主任医师，硕士生导师，主要从事临床应用解剖学方面的研究。zfh4865@163．com
