指动脉皮支解剖学研究及其临床意义

发布时间：2018-02-12 16:12

本文关键词： 指动脉指神经外科皮瓣应用解剖位置关系皮支　出处：《山东大学》2007年硕士论文　论文类型：学位论文

【摘要】： 目的本实验通过对指动脉及其皮支的起止、走行、数量、血管外径、血供分布范围、交通吻合情况进行解剖观测，为临床仅以指动脉为蒂而不必携带指掌侧固有神经的指动脉岛状皮瓣的临床应用，以及指动脉皮支皮瓣的临床应用提供解剖学依据。方法在20侧经动脉灌注红色天然橡胶乳浆灌注液的新鲜成人尸体手标本上，应用手术显微镜系统解剖观测指动脉及其皮支的起止、走行、数量、血管外径、血供分布范围、交通吻合情况；观察指动脉与指掌侧固有神经的走行关系；观察指动脉皮支与指掌侧固有神经主干的位置毗邻关系。结果每条指掌侧固有动脉在手指每节平均发出4条较小的掌侧支，优势侧动脉，即示指、中指尺侧，环指小指桡侧可发出4条以上的掌侧支。指掌侧动脉有规律的向背侧发出4条分支，即髁支、干骺支、背侧皮支和掌横弓。掌皮支在同一指侧的分布较均匀，近节指骨节段掌皮支发出点平均间隔4～11mm，最大间隔12.8mm最小间隔1mm。远节指骨节段掌皮支发出点平均间隔2～5mm，最大间隔10.8mm最小间隔1mm。指掌侧固有动脉向背侧发出比较恒定的分支有4条：近节指骨中、远1／3交界处发出第一分支，外径0.46±0.11mm，斜向近侧指间关节的背侧走行。第二分支自中节指骨基底部发出，外径0.44±0.12mm，向后向远侧斜行，分布于中节背侧皮肤。第三分支由中节指骨远侧发出，外径0.38±0.08 mm，分布于远侧指间关节背侧皮肤。第四分支自末节指骨基底部发出，分布于甲根背侧皮肤，外径0.40±0.10 mm，桡尺侧分支呈对称分布，末梢在背侧中线两侧吻合成网。指掌侧固有动脉的掌侧皮支比较多，每间隔0.9 cm即有一细小皮支穿出，指动脉皮支按与指固有神经的比邻关系分为可分为3型：①外侧优势型：皮支多行经神经外侧；外侧皮支数量为内侧皮支数量的1.5倍以上。②均势型：行经神经内外侧的皮支数量均等，皮支数量相差在1.5倍范围以内，不包括比例为1.5的。③内侧优势型。内侧皮支数量为外侧皮支数量的1.5倍以上。在手指近节，在手指中节，为外侧优势型。在手指末节，两侧指固有向中央靠拢并吻合成弓，发出的的皮支多经神经内侧至皮肤。为内侧优势型。结论及意义指动脉掌皮支数量多，，位置较恒定，外径较粗。向背侧发出的第一、二、三分支位置恒定，走行距离较长，皮瓣切取范围较大，以指动脉的皮支为蒂可设计为穿支皮瓣。皮瓣应斜向指端方向设计，最远点到达对侧中线，可用于修复指掌侧或侧面的皮肤缺损，也可带上指背神经以恢复缺损区的感觉功能。在设计皮瓣时，皮瓣沿手指方向的宽度不应小于1.0 cm，以保证皮瓣的血运。皮瓣分离层次在腱鞘与脂肪组织之间。皮瓣远端可达对侧中线。切取不带指掌侧固有神经的指动脉岛状瓣时，因手指中节皮支多经神经外侧发出，在此处切取皮瓣时，应将神经向内侧分出，以免损伤皮支导致皮瓣血管障碍；在手指近节切取指动脉皮瓣时，指固有神经从皮瓣内侧或外侧分离出皆可，但从内侧分离相对更安全一些。
[Abstract]:The purpose of the experiment based on digital artery and its cutaneous branch of the start stop, go, number, vessel diameter, blood supply distribution, traffic anastomoses were observed for clinical only refers to the artery pedicle without clinical application of finger artery island flap with palmar digital nerve, and the clinical application the flap of cutaneous branches of the artery and provide anatomic basis.
Methods 20 perfused with red emulsion perfusion liquid natural rubber fresh adult cadaver specimens, using surgical microscope system anatomic observation of digital artery and its cutaneous branch of the start stop, go, number, vessel diameter, blood supply distribution and anastomosis; observe the finger artery and palmar digital nerves relationship; observe the cutaneous branches of the digital arteries and proper palmar digital nerve trunk position and adjacent relationship.
The results of each palmar digital artery in each finger and an average of 4 smaller palmar branches, dominant side artery, the index finger, middle finger ulnar, radial finger can emit more than 4 palmar branches of the ring finger. Palmar artery dorsal law issued 4 branches, namely the condyle, metaphysis branch of dorsal cutaneous branch and transverse palmar arch. The palmar cutaneous branch on the same side of the finger is distributed evenly, the proximal phalanx segment of the palmar cutaneous branch of a mean interval of 4 ~ 11mm, the maximum interval minimum 12.8mm interval 1mm. distal phalanx segment of the palmar cutaneous branch of a mean interval of 2 ~ 5mm, the maximum interval minimum 10.8mm interval 1mm. palmar digital artery dorsal branches of a relatively constant 4: the proximal phalanx, far 1 / 3 at the junction of a first branch diameter of 0.46 + 0.11mm, oblique dorsal proximal interphalangeal joint of the second branch line. Since the middle phalanx base a diameter of 0.44 + 0.12mm, back to the far side Oblique, distributed in dorsal skin. In section Third branches by the middle phalanx of the far side of a diameter of 0.38 + 0.08 mm, distributed in the dorsal distal interphalangeal joints of the skin. The fourth branches from the phalanx base issued, distributed in the Jiagen dorsal skin, diameter of 0.40 + 0.10 mm, radial and ulnar branch was the symmetrical distribution terminals in the dorsal midline on both sides of the anastomosis. Palmar digital artery of the palmar cutaneous branch more, every 0.9 cm that is a tiny cutaneous branch out,
The cutaneous branches of the digital arteries and proper digital nerve according to the neighbor relation is divided into can be divided into 3 types: lateral advantage type: cutaneous branches treated by nerve lateral; lateral cutaneous branches of medial cutaneous branch number is 1.5 times the amount of the balance of power. Type: for cutaneous branches of equal number by nerve medial and lateral cutaneous branches. The number of phase difference of 1.5 times within the scope does not include the ratio of 1.5. The medial cutaneous branches of medial type. The number of lateral cutaneous branches of 1.5 times the amount of the above. In the proximal part of the finger, the finger in the middle section of lateral type. In the distal fingers on both sides, refers to the inherent close to central and kiss the bow, the cutaneous branches of the nerve medial to the skin. As the medial type.
Conclusion and significance of the palmar cutaneous branch of digital artery number, the position is relatively constant, diameter is first, second. The back side of a branch, three location constant, traveling long distances, the flap range is larger, with cutaneous branches of the digital artery can be designed as perforator flap. The flap should be inclined to the direction of the finger tip design. Far reaching the opposite line, can be used to repair the palmar or lateral skin defect, can also carry on the dorsal nerve to restore the defect in the design. The sensory function of skin flap, flap along the width direction of the fingers should not be less than 1 cm, to ensure the blood supply of the flap. The flap at the level of the tendon sheath and separation adipose tissue. The distal end of the flap up to contralateral midline. Cut without palmar digital nerve finger artery island flap, with a finger in the nerve lateral cutaneous branch section issued here when the flap was incised, the nerve should be separated to the medial cutaneous branch flap, so as not to damage the cause In the proximal phalanx, the right nerve can be separated from the medial or lateral side of the flap, but separation from the inside is safer.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

【相似文献】