胫骨血运的解剖研究及不同术式对胫骨血运的影响

发布时间：2018-03-26 05:50

本文选题：胫骨　切入点：血运　出处：《大连医科大学》2006年硕士论文

【摘要】： 目的:胫骨骨折临床上较为常见,胫骨干骨折,特别是胫骨中下段骨折愈合较慢、甚至发生骨不连。众所周知,胫骨的血供受损是导致骨不连的重要因素。多年来,众多学者对胫骨的血运进行了大量的研究,但对胫骨血运的来源、分布特点的描述不尽相同且不够详尽。进一步对胫骨血运进行更为详尽的解剖学研究,探讨最佳的手术方式以减少对胫骨血运的破坏具有重要的临床意义。为此,我们通过血管灌注和解剖实验对胫骨血供来源及血管分布特点进行研究,并比较观察应用不同术式对胫骨血供的影响。本试验的目的:1)进一步研究胫骨的血运分布及其特点以指导临床;2)通过对不同术式对胫骨血运的影响的比较,为应用微创钢板接骨技术(MIPO技术)治疗胫骨骨折提供形态学基础。方法:(1)胫骨血运的解剖学观察:采集新鲜成人下肢标本16例(左、右各半),用预先配制的红色乳胶经股动脉加压灌注, 10%甲醛固定;解剖时取下肢前正中切口,紧贴皮下游离剥除皮肤;显露隐神经、大隐静脉、小隐静脉,予以旁置或切断;自胫骨前面上端小心剥离皮下组织暴露出胫骨前方血管分支;由胫骨两侧贴骨与肌肉之间的间隙剥离暴露胫前、后动脉及其分支,予测量标记. (2)临床不同术式对胫骨血运的影响:采用10具新鲜成人尸体(年龄22～50岁。实验在人体死亡后8小时内进行,尸体冷藏保存。手术方法:实验分两组:传统手术组(对照组)和微创钢板接骨手术组(Minimally Invasive Plate Osteosynthesis, MIPO),实验组每组随机选用双侧肢体。实验在完整的胫骨上进行。传统手术组采用胫骨前内侧入路,分离胫骨中下段内侧骨肌间隙,保留骨膜;微创组在胫骨中下段前内侧做3个长约1.2cm切口锐性分离胫骨内侧骨与肌间隙形
[Abstract]:Objective: tibial fractures are common clinically, and fractures of the tibial shaft, especially those of the middle and lower tibia, heal slowly, or even nonunion. It is well known that the impairment of the blood supply of the tibia is an important factor leading to nonunion. Many scholars have done a lot of research on tibial blood circulation, but the description of the origin and distribution of tibial blood circulation is different and not detailed enough. It is of great clinical significance to explore the best operative method to reduce the damage to tibial blood supply. Therefore, we studied the origin and distribution of blood supply of tibia by vascular perfusion and anatomical experiments. Objective: 1) to further study the distribution and characteristics of tibial blood circulation in order to guide clinical practice. (2) by comparing the effects of different surgical procedures on tibial blood supply, we compared the effects of different surgical procedures on tibial blood supply. To provide morphological basis for the treatment of tibial fractures with minimally invasive plate technique and MIPO technique. Methods Anatomical observation of tibial blood circulation: 16 fresh adult lower limb specimens (left and right half of each) were perfused with premade red latex through femoral artery and fixed with 10% formaldehyde. The skin was removed closely to the skin, the saphenous nerve, the great saphenous vein and the small saphenous vein were exposed, and the anterior branch of the tibia was exposed by careful exfoliation of the subcutaneous tissue from the anterior end of the tibia. The anterior and posterior tibial arteries and their branches were exposed by dissecting the gap between the tibia and the muscles. Effect of different clinical procedures on tibial blood flow: 10 fresh adult cadavers (22 ~ 50 years old) were performed within 8 hours after death. Cryopreservation of cadavers. Methods: the experiment was divided into two groups: traditional operation group (control group) and minimally invasive plate grafting group (minimally Invasive Plate steosynthesism). Each group in the experimental group was randomly selected bilateral limbs. The experiment was carried out on the intact tibia. The anterior medial tibial approach was used in the operation group. Separation of the middle and lower tibia medial osseous space and preservation of periosteum; minimally invasive group made three 1.2cm incisions for sharp separation of medial tibial bone and muscle space
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R322;R687.3

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