穿支蒂皮神经营养血管皮瓣修复膝部软组织缺损的解剖学研究

发布时间：2018-07-07 07:13

本文选题：膝部 + 软组织缺损　；参考：《福建医科大学》2012年硕士论文

【摘要】：目的：通过血管灌注、显微解剖的方法，研究膝上穿支血管组（主要为膝降动脉、股内侧肌动脉和乆窝直接动脉）的走行与分布，股部三条皮神经的营养血管间的分布，以及这些血管相互间的吻合关系，，主要目的:①为修复膝部的软组织缺损，设计膝周穿支蒂皮神经营养血管皮瓣并提供解剖学基础；②为显微外科学探索、挖掘新的皮瓣术式。方法：30侧成人下肢标本，动脉内灌注红色乳胶并显微解剖观测：①股内侧肌动脉、乆窝直接穿动脉和膝降动脉的起源与外径、走行与分支；②股内侧皮神经、股中间皮神经和股后皮神经的走行与分布；③上述动脉穿支与上述皮神经的营养血管间具体吻合关系。显微解剖观测总结后另在3侧新鲜标本上分别进行术式设计并摹拟。结果：①皮神经体表投影：股内侧皮神经为腹股沟韧带中点与股骨内侧髁的连线；股中间皮神经前支为腹股沟韧带中点与髌骨中点至收肌结节连线中点的连线；股后皮神经于臀大肌下缘中点穿出，主干沿股后正中线下行；②穿支血管穿出点：股部皮神经营养血管均为多节段性、多源性，而膝降动脉、股内侧肌动脉和乆窝直接动脉均有位置相对恒定的皮穿支血管。A.膝降动脉穿支:恒定位于大收肌腱外侧缘、股骨内侧髁上缘与股内侧肌内侧缘所围成的三角形凹陷内；B.股内侧肌穿支:腹股沟中点与收肌结节连线中、下1／3交界点与髌骨中点连线的中点；C.乆窝直接动脉穿支:膝关节正中平面上7～11cm处。结论：①掌握了膝上穿支血管组的解剖规律与股内侧皮神经、股中间皮神经和股后皮神经的解剖学规律与形态学特征，明确了膝周动脉穿支血管与膝周皮神经营养血管间存在着众多的吻合关系；②可设计成膝降动脉穿支蒂股内侧皮神经营养血管皮瓣、股内侧肌穿支蒂股中间皮神经营养血管皮瓣和乆窝直接动脉穿支蒂股后皮神经营养血管皮瓣，解剖学研究证实这些皮瓣可应用于修复膝部软组织缺损；③与传统皮瓣相比，穿支蒂皮神经营养血管皮瓣优点明显，蒂部小创伤少而血供可靠、设计灵活且为邻近转移操作方便，丰富了膝部软组织缺损修复的方法。
[Abstract]:Objective: to study the route and distribution of superior genicular perforating artery group (mainly descending genicular artery, medial femoral muscle artery and direct artery of the femoral fossa) and the distribution of nutrient vessels of the three cutaneous nerves in the femoral region by means of blood vessel perfusion and microdissection. In order to repair the soft tissue defect of the knee, to design the cutaneous neurovascular flap of the perforating branch of the knee and to provide the anatomical basis for the exploration of microsurgery, to explore the new flap operation method in order to repair the soft tissue defect of the knee region, and to provide the anatomical basis for the anastomosis of these vessels. Methods in 30 adult lower extremity specimens, red latex was infused into the artery and the medial femoral artery of 1: 1 was observed. The origin and external diameter of the medial femoral artery and the descending genicular artery were observed. The route and distribution of the middle femoral cutaneous nerve and the posterior femoral cutaneous nerve. 3 the relationship between the perforating branch of the artery and the nutrient vessels of the above mentioned cutaneous nerve is specific. The surgical methods were designed and imitated on 3 fresh specimens after microanatomical observation. Results the medial femoral cutaneous nerve was the midpoint of the inguinal ligament and the medial femoral condyle, the anterior branch of the femoral middle cutaneous nerve was the midpoint of the inguinal ligament and the midpoint of the patella to the adductor tubercle, and the medial femoral cutaneous nerve was the line between the midpoint of the inguinal ligament and the midpoint of the adductor tubercle. The posterior femoral cutaneous nerve was perforated at the middle point of the inferior margin of gluteus maximus, and the main trunk was descending along the posterior median line of the femur. The medial femoral muscle artery and the medial femoral fossa direct artery have a relatively constant position of the cutaneous perforator artery. A. The perforating branch of descending genicular artery is located in the lateral margin of adductor Magnus tendon, the medial femoral condylar edge and the medial femoral muscle medial margin. The perforating branch of medial femoral muscle: the midpoint of inguinal midpoint and adductor tubercle, the midpoint of inferior one-third junction point and midpoint of patella. The direct perforating branch of the artery: 7~11cm on the median plane of the knee joint. Conclusion the anatomical rules and morphological features of medial femoral cutaneous nerve, middle femoral cutaneous nerve and posterior femoral cutaneous nerve were grasped in the vascular group of superior genicular perforating branch. It is clear that there are many anastomoses between the perforating vessels of the genicular artery and the nutrient vessels of the perigenicular cutaneous nerve. 2 the medial cutaneous neurovascular flap pedicled with the perforating branch of the descending genicular artery can be designed. Medial femoral muscle perforator pedicled medial femoral cutaneous neurovascular flap and posterior femoral cutaneous nerve nutrient vascular flap pedicled with perforating branch of the femoral fossa. Anatomical studies confirmed that these flaps could be used to repair soft tissue defect in knee. The perforating cutaneous neurovascular flap has obvious advantages such as little trauma and reliable blood supply, flexible design and convenient operation for adjacent transfer, which enriches the method of repairing knee soft tissue defect.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322

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