胸大肌岛状肌皮瓣转移过程的应用解剖学研究

发布时间：2018-01-31 19:14

本文关键词： 胸大肌肌皮瓣应用解剖学胸外侧神经锁骨　出处：《大连医科大学》2005年硕士论文　论文类型：学位论文

【摘要】：目的:关于胸大肌岛状肌皮瓣转移过程的应用解剖学研究报道很少。随着功能外科的发展,肌皮瓣转移过程中减少副损伤以及对供区的形态与功能的保护日益受到重视。本课题通过对胸大肌岛状肌皮瓣转移过程的应用解剖学研究,掌握支配胸大肌锁骨部的神经的解剖学特点,明确胸大肌岛状肌皮瓣的主要血管蒂与锁骨部神经的解剖学关系。在胸大肌岛状肌皮瓣转移过程中,寻求新的可行性转移方式,能有效避免锁骨部的神经损伤、保护胸大肌锁骨部的形态与功能。为临床上合理、安全、方便地使用胸大肌岛状肌皮瓣修复头面、颈肩部的组织缺损提供解剖学依据。方法:1、解剖学研究: 采用巨微解剖学方法,随机选取 30具国人人体标本行双侧解剖。(1)胸大肌锁骨部的解剖学特点和三角肌胸大肌间隙处的内部特点观察并记录。(2)位于胸小肌上缘的胸肩峰动脉暴露出来,支配锁骨部的神经被解剖出来, 观测并记录支配胸大肌锁骨部神经的起始、走行和分支分布情况。(3)支配胸大肌锁骨部的神经与胸肩峰动脉的胸肌支的空间关系被观测并记录。2、随机选取 6 具国人人体标本行模拟岛状肌皮瓣转移手术实验, 分别在血管蒂起始处的内侧经锁骨上、下转移肌皮瓣,在血管蒂起始处的外侧经锁骨上转移肌皮瓣。(1)比较三种转移方式的有效修复范围和肌肉血管蒂的有效长度。(2)描绘各自转移特点,观察并记录副损伤情 2 况和肌皮瓣及其肌肉血管蒂对锁骨部神经的影响情况。3、数据结果采用 SPSS10.0 统计学软件处理并分析。结果:1、解剖学研究结果:(1) 胸大肌锁骨部肌腹长度为 12.6±1.3cm, 起始部位宽厚分别为 5.8±0.8cm 和 0.9±0.1cm, 止端的宽厚分别为 4.8±0.2cm 和 0.7±0.1cm。胸大肌三角肌间沟内无神经跨越。头静脉沿胸大肌三角肌间沟区筋膜深面上行。(2)胸外侧神经的“1 支型”分支和“2、3 支型”分支中的第一个分支即为支配胸大肌锁骨部的神经。该神经从臂丛发出后向下外走行,于锁骨后方,锁骨下肌深面到达胸部。神经经锁骨下至胸部时与锁骨下缘相交体表投影点距同侧胸锁关节的距离为 6.28±0.73cm( ±s,n=60)。(3)支配胸大肌锁骨部的神经从锁胸筋膜穿出的位置位于胸肩峰动脉的胸肌支起始处的颅内侧,神经分支的走行均位于血管蒂的浅层,血管走行的内侧。大部分神经的分支进入肌肉的部位分布于血管蒂的内侧区域。2、模拟手术实验结果。(1)血管蒂起始处的内侧经锁骨下转移方式其有效修复范围和肌肉血管蒂的有效长度均较其它二种方式大,但是组织副损伤和神经捻挫机率也大。(2)血管蒂起始处的内侧经锁骨上转移,其有效修复范围偏向内侧,肌肉血管蒂的有效长度与沿血管蒂起始处的外侧经锁骨上转移相比无显著性差异。神经捻搓和副损伤机率大。(3)沿血管蒂起始处的外侧经锁骨上转移,无神经副损伤,血管蒂跨过锁骨时的突出程度减轻,肌皮瓣和血管蒂与该神经不发生牵拉捻挫现象。结论:1、胸大肌锁骨部从肌构筑学上具有提供较大的力量和速度的潜力。肌皮瓣转移过程中应避免损伤支配该部位的神经,以避免该部位失神经支配而丧失功能。2、胸外侧神经 “1 支型”分支和 “2、3 支型”分支中的第一个分支即为支配胸大肌锁骨部的神经。神经经锁骨下至胸部时与锁骨下缘相交体表投影点距同侧胸锁关节 6.28+0.73cm 至 6.28-0.73cm 的范围为该神经的手术操作危险区。3、在解剖研究基础上,由于支配胸大肌锁骨部的神经的大部分神经分支位于血管蒂的浅层、内侧,所以在血管蒂起始部位外侧,通过三角肌胸大肌间沟经锁骨上转移岛状肌皮瓣的方法,能有效的避免锁骨部神
[Abstract]:Objective: to report about applied anatomy of pectoralis major myocutaneous flap transfer process. With the development of surgery rarely function, protect the muscle flap transfer to reduce collateral damage in the process as well as the shape and function of supply site has received increasing attention. This topic through the application of the anatomic study of the pectoralis major myocutaneous flap transfer process, the anatomical features of the master control of theclavicular part of the pectoralis major muscle nerve, anatomical relationship between vascular pedicle and clavicular nerve clear pectoralis major myocutaneous flap. The pectoralis major myocutaneous flap in the process of seeking feasible new transfer mode, can effectively avoid the nerve injury of the clavicular part of the form with the function of protecting the clavicular part of pectoralis major. For clinical reasonable, safe, convenient use of pectoralis major myocutaneous flap to repair the head, to provide anatomical basis for the shoulder and neck tissue defect.
Methods: 1 anatomic study: microsurgical anatomy method, randomly selected 30 Chinese human specimens were dissected. (1) the anatomical features of deltoid and pectoralis major muscle at theclavicular part of the pectoralis major muscle internal characteristics were observed and recorded. (2) is located on the edge of the pectoralis minor chest shoulder peak artery exposed, dominating the clavicular part of the nerve were dissected out and start observing and recording the dominant clavicular part of pectoralis major muscle nerve, walking and distribution. (3) dominated theclavicular part of the pectoralis major muscle and nerve of thoracoacromial artery pectoral branches of the spatial relationship between the observation and recording.2, randomly selected in 6 cadavers the human body specimens simulating island flap transfer surgery experiment, respectively in the vascular pedicle at the start of the medial clavicle, transfer flap, lateral vascular pedicle at the start of the supraclavicular myocutaneous flaps (1). The effective range of three kinds of repair and muscle transfer The effective length of the meat vessel pedicle. (2) depict the characteristics of each metastasis, observe and record the injury of the secondary lesion
Two
The effect of myocutaneous flap and its muscular vessel pedicle on the nerve of the clavicle.3, data results
SPSS10.0 statistical software was used to deal with and analyze.
Results: 1. The anatomical results were as follows: (1) the length of the muscle belly of the clavicle of the pectoralis major muscle was
12.6 + 1.3cm, the width of the initial site was 5.8 + 0.8cm and 0.9 + 0.1cm, and the width of the end was wide.
There were no nerve leaping in the inter deltoid ditches of the pectoralis major muscle of 4.8 + 0.2cm and 0.7 + 0.1cm., respectively.
The veins are along the deep fascia of the deltoid deltoid region of the pectoralis major muscle. (2) "1 branches of the lateral thoracic nerve.
The first branch of the branch and the "2,3 branch" branch is the clavicle of the pectoralis major muscle
The nerve. The nerve goes down from the brachial plexus down, behind the clavicle, and the subclavian muscle is deep.
Arrive the chest. Nerve subclavian to the chest and the lower edge of the clavicle with intersecting surface projection point
The distance of the side thoracic lock joint was 6.28 + 0.73cm (+ s, n=60). (3) dominating the pectoralis major muscle
The position of the nerve of the clavicle from the latch fascia is located at the beginning of the thoracic muscle branch of the thoracic acromion artery.
The inside of the cranium, the branches of the nerve are located in the superficial layer of the pedicle of the vessel, and the blood vessels walk on the inside.
Most of the branches of the nerve enter the part of the muscle and distribute in the medial region of the vascular pedicle,.2.
The results of a quasi operative experiment. (1) the medial subclavian transfer of the pedicle at the pedicle of the vascular pedicle
The effective length of the repair and the effective length of the pedicle of the muscle vessels are larger than those of the other two methods, but the tissue
The rate of secondary injury and nerve twisting is also great. (2) the medial supraclavicular transfer of the pedicle at the pedicle of the vessel
The effective repair range is on the medial side, the effective length of the pedicle of the muscle vessel and the pedicle of the vascular pedicle
There is no significant difference in the lateral subclavicular metastasis of the beginning. The probability of nerve twisting and accessory injury
(3) the lateral passage of the clavicle along the lateral part of the pedicle of the vascular pedicle without nerve and accessory injury.
The protrusion of the pedicle relieved when the clavicle crossed the clavicle, and the musculocutaneous and vascular pedicles were not associated with the nerve.
Twisting and twisting.
Conclusions: 1, the clavicle of the pectoralis major muscle provides greater strength and speed from the muscular architecture.
The potential of the musculocutaneous flap should be avoided during the process of myocutaneous flap transfer.
The loss of function.2, the "1 type" branch of the lateral thoracic nerve and the branching of the lateral thoracic nerve.
The first branch of the "2,3 branch" branch is the nerve that dominates the clavicle of the pectoralis major muscle.
The subclavian to the chest with the ipsilateral clavicle intersects the surface projection point of sternoclavicular joint
The range of 6.28+0.73cm to 6.28-0.73cm is the risk area of.3 for the operation of the nerve.
On the basis of anatomical studies, most of the nerve branches of the nerve of the clavicular part of the pectoralis major muscle are controlled.
It is located in the superficial layer of the vascular pedicle, inside, so in the lateral of the pedicle of the vascular pedicle through the deltoid
The intermuscular ditches through the clavicle transfer the island - like myocutaneous flap to effectively avoid the clavicle.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R622;R322

【引证文献】