前臂桡动脉穿支皮瓣的解剖学研究及临床应用

发布时间：2018-03-18 07:30

本文选题：前臂　切入点：桡动脉　出处：《福建中医药大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的通过研究前臂桡动脉穿支血管的解剖学特点,为前臂桡动脉穿支皮瓣的设计及临床应用提供解剖学依据,为修复手部创面及功能重建提供方法,并报道初步临床应用效果。方法①18侧红色乳胶灌注的成人上肢标本,以桡骨茎突为观测标志点,重点显微解剖前臂下1/3段,对前臂桡动脉的主要血管分布及其吻合,前臂桡动脉及其发出的穿支血管行显微解剖(放大5倍),并观察它们的起始、管径、走行、分支及分布情况。②从2008年6月至2010年1月,运用前臂桡动脉穿支皮瓣修复手部创面及手部功能重建,同时术后应用中药：活血止痛汤治疗5例。结果前臂桡动脉发出的穿支血管约14支,近侧段数目较少(平均3支)但口径较大,远侧段数目较多(平均11支)但口径较小,在上1/3处发出1～3支肌穿支,中1/3处发出2～3支穿支,下1/3处发出3～7支穿支。桡动脉两侧发出的穿支外径(0.7±0.4)mm,各穿支动脉发出分支沿纵行方向相互吻合。桡动脉主要穿支血管：①桡动脉背侧浅支：穿过肱桡肌腱后于其外侧下降,起点距桡骨茎突上(7.0±1.1)cm,起始外径(0.6±0.3)mm,并分为细短的升支和粗长的降支；②桡动脉掌浅支：桡动脉于前臂下1/3段近腕横纹处发出掌浅支,起点距桡骨茎突上(1.5±1.0)cm,起始外径(1.5±0.2)mm,长(2.3±1.0)cm；③桡骨茎突返支：于鼻烟窝内,桡动脉或腕背支近端发出桡骨茎突返支1～2支,起点距桡骨茎突(0.5±0.3)cm,长(1.0±0.5)cm,起始外径(0.8±0.1)mm。茎突返支分茎突骨膜支、穿支及头静脉营养血管,起始外径(0.5±0.2)mm；④桡动脉鼻烟窝支：桡动脉从桡骨茎突的远端斜向外下,行于拇长展肌腱和拇短伸肌腱的深面。在桡动脉鼻烟窝近段,或由其腕背支的近端发出穿支1～2支,起点距桡骨茎突下(1.2±0.3)cm,外径(0.6±0.1)mm；⑤动脉骨皮穿支：在距桡骨茎突上(8.0～16.0)cm之间,桡动脉肌间隙骨皮穿支1～3支,起始外径(1.2±0.2)mm。临床运用于5位患者术后均常规服用活血止痛汤,病例2与4术后皮肤张力较高,出现张力性水泡,病例2术后三天皮瓣及边缘出现紫暗,服用活血止痛汤后皮肤张力及水泡消退明显,疗效确切,病例4皮瓣完全存活、病例2皮瓣外侧缘部分约2cm×2cm不死,经换药后痊愈。其余病例皮瓣及植皮区完全存活,皮瓣无明显臃肿,外形良好,拇指外展功能恢复满意。结论前臂远侧有多源性供血的解剖学规律,桡动脉穿支在前臂中下1/3段分布密,前臂桡动脉穿支皮瓣内部动脉穿支互相吻合成网,形成链式供血,营养皮下组织及皮肤。临床上可以设计前臂桡动脉穿支皮瓣来修复手部皮肤软组织缺损及手部功能重建,其具有血供可靠,邻近取材、转移,皮肤质地好,符合“相似组织替代”原则,成活率较高,1术程短,术中出血少,是临床修复手部皮肤软组织缺损及手部功能重建的良好供区。
[Abstract]:Objective to study the anatomical characteristics of perforating branch of radial artery of forearm, to provide anatomic basis for the design and clinical application of perforating branch flap of radial artery of forearm, to provide methods for repairing the wounds and functional reconstruction of hand, and to report the preliminary clinical application effect. Methods 118 adult upper limb specimens infused with red latex were studied. The radial styloid process was used as the observation marker. The 1/3 segments of the lower forearm were dissected microscopically. The distribution and anastomosis of the main vessels of the radial artery of the forearm were analyzed. The radial artery of the forearm and its perforating vessels were dissected (magnified by 5 times, and their origin, diameter, course, branch and distribution) were observed from June 2008 to January 2010. The radial artery perforator flap of forearm was used to repair the hand wound and hand function reconstruction, and 5 cases were treated with Huoxue Zhitong decoction after operation. Results there were about 14 perforating vessels from the radial artery of the forearm. The number of proximal segment was less (average 3) but the diameter was larger, the distal segment was more (average 11), but the diameter was smaller. Two or three perforating branches were sent out at 1/3, The external diameter of perforating branch from both sides of radial artery was 0.7 卤0.4 mm, and the branches of perforating artery were anastomosed in the longitudinal direction. The main perforating branch of radial artery: 1 superficial dorsal branch of radial artery: after passing through the tendon of radial brachialis, the radial artery was descending on the lateral side. The starting point was 7.0 卤1.1 cm above the styloid process of the radius, and the starting external diameter was 0.6 卤0.3 mm. The radial artery was divided into two branches, the short ascending branch and the long descending branch, the palmar branch of the radial artery: the radial artery sent out the superficial palmar branch at the proximal carpal striae at the lower 1/3 segment of the forearm. The starting point was 1.5 卤1.0 cm above the styloid process of the radius, 1.5 卤0.2 mm in external diameter, 2.3 卤1.0 mm in length and 2.3 卤1.0 cm ~ (-1) in the recurrent branch of the styloid process of the radius. In the nasal fossa, 12 branches of the recurrent branch of the styloid process of the radius, 0.5 卤0.3 cm, 1.0 卤0.5 cm, 0.8 卤0.1 mm of the recurrent branch of the styloid process, 12 branches of the recurrent radial artery or dorsal branch of the wrist, 0.5 卤0.3 cm, 1.0 卤0.5 cm, and 0.8 卤0.1 mmm. of the recurrent branch of the styloid process, respectively. Nutrient vessels of perforating branch and cephalic vein, starting with external diameter of 0.5 卤0.2mm. 4 branch of snuff fossa of radial artery: radial artery was located at the deep surface of abductor pollicis longus tendon and extensor pollicis brevis tendon from the distal end of the styloid process of the radius, and at the proximal segment of the snuff fossa of the radial artery. Or two perforating branches from the proximal end of the dorsal carpal branch, starting point 1.2 卤0.3 cm from the inferior styloid process of the radius, and the external diameter of 0.6 卤0.1 mm to 5 perforating branches of the artery: between 8.0 and 16.0 cm above the styloid process of the radius, the perforating branch of the musculocutaneous space of the radial artery was 13. The initial external diameter was 1.2 卤0.2 mm 路m ~ (-1). Five patients were treated with Huoxue Zhitong decoction. Cases 2 and 4 had high skin tension, tension blisters, and purple dark skin flap and edge 3 days after operation in case 2. After taking Huoxue Zhitong decoction, the skin tension and blisters subsided obviously, and the curative effect was definite. The skin flap of case 4 completely survived, the lateral edge of case 2 was undead about 2 cm 脳 2 cm, and recovered after dressing change. The rest of the flap and skin grafting area survived completely. There was no obvious bloated skin flap, good appearance and satisfactory recovery of thumb abduction function. Conclusion there is an anatomical rule of multisource blood supply in the distal forearm. The perforating branch of radial artery is closely distributed in the 1/3 segment of the middle and lower forearm. The perforating branch of the radial artery flap anastomoses with each other to form a chain blood supply. Nutritional subcutaneous tissue and skin. Clinically, we can design the perforating branch flap of radial artery of forearm to repair the defect of skin and soft tissue of the hand and the reconstruction of hand function. It has reliable blood supply, adjacent materials, transfer and good texture of the skin. According to the principle of "similar tissue replacement", the survival rate is higher and the operative procedure is short, and the bleeding is less. It is a good donor area for clinical repair of hand skin and soft tissue defect and hand function reconstruction.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322

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