背阔肌复合组织瓣重建上肢运动功能的解剖学研究

发布时间：2018-05-11 11:57

本文选题：背阔肌 + 复合组织瓣　；参考：《广西医科大学》2010年硕士论文

【摘要】： 目的：探索增强背阔肌远端肌力的方法及背阔肌邻近可以协同其重建上肢运动功能的肌肉,为背阔肌复合组织瓣重建上肢运动功能提供解剖学依据。方法：通过解剖16侧10%福尔马林液固定成人尸体标本,观察背阔肌远端与邻近肌肉的关系及穿入背阔肌远端的肋间后血管、脊神经后支,观察同侧背阔肌与前锯肌的形态、血管、神经以及位置关系。使用spss13.0统计软件进行数据统计。结果：背阔肌远端腱膜表面有厚19.3±5.69mm的浅筋膜覆盖,与下后锯肌起点及竖脊肌表面的胸腰筋膜愈合紧密,愈合处胸腰筋膜长13.5±3.71cm、宽6.79±2.44 cm,腱膜增厚至1.45±0.19mm；下后锯肌、竖脊肌紧贴于背阔肌远端深面,血供来自肋间后动脉及腰动脉,接受相应体节的脊神经后支节段性支配。背阔肌远端有血管、神经伴行自肌肉深面穿入,血管为肋间后动脉分支、腰动脉分支,仅1～2支外径较粗大；脊神经后支伴随肋间后动脉的分支或腰动脉的分支穿过背阔肌远端。前锯肌下部肌齿于第6～9肋水平紧贴在胸壁外侧的背阔肌深面；背阔肌与前锯肌下部共血管干,主要接受收胸背动脉的血供,血管外径2.18±0.46mm、血管蒂部长达9cm以上；背阔肌、前锯肌有独立的神经支配。前锯肌下部肌齿之间存在夹角,肌齿内肌纤维以止点为中心呈放射状向胸前外侧分布；胸长神经对前锯肌的神经支配呈明显节段性,下行过程发出8～10支细、短分支支配前锯肌各个肌齿。结论：1.带背阔肌远端胸腰筋膜及增厚浅筋膜的背阔肌复合组织瓣可以加强背阔肌远端的组织结构。 2.下后锯肌、竖脊肌不适合与背阔肌形成背阔肌复合组织瓣应用于上肢运动功能重建。 3.带前锯肌下部的背阔肌复合组织瓣可以应用于上肢运动功能重建。
[Abstract]:Objective: to explore the method of enhancing the distal muscle strength of latissimus dorsi and to provide anatomic basis for the reconstruction of motor function of upper limb by the muscle adjacent to latissimus dorsi muscle. Methods: 16 adult cadavers fixed with 10% formalin solution were dissected to observe the relationship between the distal part of latissimus dorsi and adjacent muscles, the posterior intercostal vessels and posterior branches of spinal nerve, and the morphology of ipsilateral latissimus dorsi and serratus anterior muscle. Blood vessels, nerves, and location. Use spss13.0 statistical software for data statistics. Results: the surface of the distal fascia of latissimus dorsi was covered with 19. 3 卤5.69mm superficial fascia, which was close to the thoracolumbar fascia at the beginning of the posterior serratus and the surface of the vertical spinal muscle. The length and width of the fascia were 13.5 卤3. 71 cm, 6. 79 卤2. 44 cm, and the aponeurosis thickened to 1. 45 卤0. 19 mm, respectively, and the posterior serratus muscle was thickened to 1. 45 卤0. 19 mm. The vertical spinal muscle is close to the distal side of the latissimus dorsi. The blood supply comes from the posterior intercostal artery and the lumbar artery and receives the segmental innervation of the dorsal branch of the spinal nerve of the corresponding body ganglia. There were vessels in the distal part of the latissimus dorsi muscle, and the nerve was perforated from the deep side of the muscle. The branches of the posterior intercostal artery and the lumbar artery were the branches of the posterior intercostal artery, and the branches of the lumbar artery and the posterior branch of the spinal nerve accompanied by the branch of the posterior intercostal artery or the branch of the lumbar artery passed through the distal part of the latissimus dorsi muscle. The lower muscle teeth of the serratus anterior muscle are close to the deep side of the latissimus dorsi outside the chest wall at the 69th rib level, and the latissimus dorsi muscle shares the trunk of the blood vessel with the lower part of the serratus anterior muscle, and mainly receives the blood supply of the adductive dorsal artery with an external diameter of 2.18 卤0.46 mm, and the vascular pedicle is more than 9cm, the latissimus dorsi muscle, The anterior serratus has an independent innervation. There is an angle between the lower muscle teeth of the anterior serratus, the fibers of the intraodontic muscle radiate to the anterolateral chest, and the long thoracic nerve innervates the anterior serratus in a segmental manner, with 810 fine fibers in the descending process. The short branches innervate the teeth of the serratus anterior muscle. Conclusion 1. The distal structure of latissimus dorsi muscle can be enhanced by the composite flap of latissimus dorsi with distal thoracolumbar fascia and thickened superficial fascia. 2. The posterior serratus and the vertical spinal muscle are not suitable for the reconstruction of motor function of the upper extremity with the latissimus dorsi complex tissue flap. 3. Latissimus dorsi composite tissue flap with lower part of serratus anterior muscle can be used to reconstruct motor function of upper limb.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322

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