腓肠内侧动脉穿支血管的解剖研究与改良腓肠内侧岛状肌皮瓣的临床应用

发布时间：2018-01-08 20:27

  本文关键词：腓肠内侧动脉穿支血管的解剖研究与改良腓肠内侧岛状肌皮瓣的临床应用　出处：《第二军医大学》2016年博士论文　论文类型：学位论文

  更多相关文章： 腓肠肌岛状皮瓣 腓肠内侧动脉 穿支血管 胫骨感染 骨外露

【摘要】：目的通过对人体解剖学观察,研究腓肠内侧动脉及其穿支血管的解剖学基础。将解剖学数据应用于临床,设计以腓肠内侧动脉为血管蒂,并包含穿支血管的改良腓肠内侧岛状肌皮瓣,探讨改良腓肠内侧岛状肌皮瓣对胫骨近端骨折术后感染伴钢板或骨外露在临床中的应用价值。方法1.选取8侧成人新鲜尸体下肢标本,经股动脉灌注乳胶硫酸钡溶液,解剖并观察腓肠内侧动脉穿支血管的数目、起始部外径、穿出点外径、血管蒂长、穿支穿出点位置。测量数据采用SPSS软件进行统计学分析。然后取2例剥离的体被组织行X线观察腓肠内侧动脉及其穿支走行情况。2.回顾性分析2013年1月至2015年6月在我科收治的15例胫骨近端骨折术后感染伴钢板或骨外露患者,其中男9例,女6例,年龄24~58岁,平均35.6岁,左侧10例,右侧5例。致伤原因:交通事故伤10例,重物砸伤3例,机械损伤2例。其中GustiloⅠ型12例,GustiloⅡ型3例,入院前均一期或分期实施了骨折复位内固定术,术后因皮肤软组织坏死感染而出现骨或内固定外露,外露时间11天~74天,平均34天。入院后术前创面分泌物细菌培养结果为金黄色葡萄球菌10例,铜绿假单胞菌2例,表皮葡萄球菌2例,鲍氏不动杆菌1例。在我科采用清创及改良腓肠内侧岛状肌皮瓣进行治疗,皮瓣大小和形状根据清创后皮肤软组织缺损大小与形状进行设计,其中切取皮瓣面积为3.6 cm×4.2 cm~5.3 cm×6.5 cm,术后对皮瓣成活率、并发症、膝踝关节功能、皮瓣受区与供区外观满意度进行随访观察。结果1.在8侧成人尸体下肢标本上,观测腓肠内侧动脉穿支血管共18支,平均2.3支,其中13支(72.2%)发自于腓肠内侧动脉后支,5支(27.8%)发自于腓肠内侧动脉前支。穿支穿出点外径平均为0.87±0.25 mm(0.6 mm~1.1 mm),穿支起始部外径平均为1.82±0.47 mm(1.3 mm~2.3 mm)。穿支蒂长为3.2 cm~8.2 cm(平均5.4 cm),血管蒂长6.5 cm~15.7 cm(平均为11.2cm)。穿支浅出点集中出现在距乆皱褶以远7.6 cm~17.8 cm(平均10.9 cm),距后正中线1.3 cm~4.2 cm(平均2.8 cm)的范围内。2.本组15例患者皮瓣均成活,14例一期愈合,1例二期愈合。本组住院时间12~50天,平均27.3天。15例患者均进行了至少6个月(6~24月)的术后随访,在末次随访中,供区愈合良好,皮肤感觉功能未见受到影响,皮瓣平整、质软柔和,患者对受区及供区外形满意。15例患者骨折最后全部愈合,无骨不连、畸形愈合、骨髓炎发生,未见明显膝踝关节功能障碍,患者生活及工作未受到明显影响。根据改良ASAMI评分系统评价疗效:优10例,良4例,中1例,差0例。结论1.腓肠内侧动脉及其穿支血管较为恒定,腓肠肌内侧岛状肌皮瓣切取时以腓肠内侧动脉为蒂,并包含穿支血管或携带其源动脉时,可获得较为稳定血供,是改良腓肠内侧岛状肌皮瓣成活的解剖学基础。2.改良腓肠内侧岛状肌皮瓣能够一期治疗胫骨近端骨折术后钢板或骨外露并感染,避免钢板取出,缩短病程,减轻患者经济负担;且皮瓣具有薄而柔软,受区外形美观,供区创伤小等优点。
[Abstract]:Objective To observe the anatomy, anatomic study of medial sural artery perforator vessels and anatomical data. The clinical application in the design to the medial sural artery as the pedicle, and the improved medial sural island flap perforator, to explore the application value with steel plate or bone exposure in clinical infection in modified medial gastrocnemius island myocutaneous flap of proximal tibial fracture after operation. Methods 1. 8 side of fresh adult lower limb specimens, the femoral artery perfusion barium sulfate latex solution, the number of dissected and observed the medial sural artery perforator, the initial part of the outer diameter of piercing point diameter, long vascular pedicle, piercing point position measurement data for statistical perforating branches. Analysis by SPSS software. Then the body was stripped from 2 cases of tissue X-ray observation of medial sural artery perforator and walking.2. were retrospectively analyzed from January 2013 to June 2015 With steel plate or bone exposure in patients with infection in our hospital from 15 cases of tibial proximal fracture after operation, 9 cases were male, 6 were female, aged 24~58 years old, average 35.6 years old, 10 cases on the left side, right side in 5 cases. The causes of injury: 10 cases of traffic accident injury, 3 cases of bruise, mechanical injury in 2 cases in 12 cases of Gustilo type, 3 cases of type II Gustilo, before admission, one stage or the phased implementation of the fracture reduction and internal fixation, postoperative necrosis of skin and soft tissue infection and internal fixation or bone exposure, exposure time 11 ~74 days, average 34 days after admission. The preoperative germiculture results 10 cases of Staphylococcus aureus in 2 cases, 2 cases of Pseudomonas aeruginosa, Staphylococcus epidermidis, Acinetobacter bacilli in 1 cases. The debridement and improvement of medial sural island flap for treatment, according to the size and shape of flaps after debridement of skin and soft tissue defect size and shape design, including flap 闈㈢Н涓，

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