胸廓内血管为蒂的肋骨复合组织瓣解剖学及其修复下颌骨缺损的研究

发布时间：2018-05-14 22:19

本文选题：下颌骨 + 胸廓内血管　；参考：《山东大学》2009年硕士论文

【摘要】： 目的: 研究胸廓内血管及其前穿支对前胸壁组织供血的解剖学要点;探索以胸廓内血管为蒂的肋骨复合组织瓣修复口腔下颌骨组织缺损的临床应用。方法: 1、解剖学研究: 1.1新鲜成人尸体胸部2具4侧,自胸廓内动静脉起始处分别灌注红、蓝乳胶墨水。观察1)胸廓内血管的起源;2)胸廓内血管诸穿支供应胸部皮肤的范围;3)胸廓内动脉诸穿支穿出胸壁的位置、走行、长度、外径、分支数目、吻合情况。 1.2 10%福尔马林固定未超过6个月的成人尸体胸部15具30侧,采用巨微解剖学方法,观察1)胸廓内血管及皮肤穿支在肌肉、皮下的走行;2)用钢尺和卡尺测量并摄影记录。测量:诸前穿支穿出胸壁的具体位置、长度、外径、分支数目、吻合情况;3)确定体表投影,设计以胸廓内血管前穿支为血管蒂的皮瓣切取范围。 2、临床初步应用:13例下颌骨缺损病例,男性7例,女性6例;年龄:22岁—55岁;缺损部位:下颌骨缺损位置以体部和升支部为多(5例),单侧角部4例,累及双侧及颏部4例,缺损最大为11 cm,伴软组织缺损5例。修复方式:以胸廓内动静脉为供区血管的肋骨复合组织瓣游离移植术8例,以胸廓内动静脉为供区血管的肋骨游离移植术5例,骨源均选择第5肋骨肋软骨。受区血管:8例选择面动静脉,4例选择甲状腺上动脉,1例选择颞浅动静脉。结果: 1.左侧17例标本有15例胸廓内动脉直接起源于锁骨下动脉,占88.2%,2例与其它动脉共干发出。右侧17例16例起源于锁骨下动脉,占94.1%,1例与其它动脉共干发出。 2.胸廓内动脉穿支动脉多起自胸廓内动脉的内侧壁,前穿支的出现率以1-4穿支最常见,出现率为100%,且口径较为粗大,各穿支之间有丰富的血管吻合现象,穿支动脉的伴行静脉多为一支。 3.穿支动脉自胸廓内动脉发出后,穿过胸内筋膜、肋间内肌、肋间筋膜和胸大肌等方可浅出。浅出处与起点间存在着一定的偏离。 4.各支穿动脉的分布区各有一个相对集中区,第2穿动脉的中心分布区在第2和3肋间隙,第3穿动脉的中心分布区,在第3和4肋间隙,第4穿动脉的中心分布区,在第4和5肋间隙,以此可确定各穿支血管所对应的供区范围。 5.13例血管化游离肋骨瓣＼骨肌皮瓣均全部成活,未见感染或坏死,未发生血管危象。结论: 1、胸廓内动脉肋间穿支动脉的出现率以2、3、4穿支最为恒定,且口径较为粗大,适合做血管吻合。血管吻合应选择胸廓内血管穿支起始端。制作皮瓣时可保留真皮下血管网,修除部分脂肪组织。 2、所切取胸前区皮瓣上下范围为该穿支所在肋间及其下一位肋间。 3、对于口腔下颌骨复合组织缺损的病例,以胸廓内血管为蒂的肋骨复合组织瓣是一种较理想的修复方法。
[Abstract]:Objective: To study the anatomical points of intrathoracic vessels and their anterior perforating branches on the blood supply of anterior thoracic wall, and to explore the clinical application of rib composite tissue flap pedicled with intrathoracic vessels to repair oral and mandibular bone defects. Methods: 1. Anatomical studies: 1.1 Red and blue latex ink were infused into the chest of 2 fresh adult cadavers from the beginning of internal thoracic arteriovenous vein. 1) the origin of intrathoracic vessels (2) the range of perforators supplied to the thoracic skin (3) the location, length, diameter, number of branches and anastomosis of the perforating branches of the internal thoracic arteries out of the chest wall. 1.2 Fifteen cadavers with 30 sides of adult cadavers less than 6 months old were fixed with 10% formalin. Giant microanatomy was used to observe 1) intrathoracic blood vessels and skin perforating branches in muscles, subcutaneous walking and 2) measuring and recording with steel and caliper. Measurement: the specific position, length, external diameter, number of branches and anastomosis of the anterior perforating branches were used to determine the projection of the body surface, and the range of the flap pedicled with the anterior perforating branch of the thoracic blood vessel was designed. 2, 13 cases of mandibular defect were treated clinically, male 7 cases, female 6 cases; age: 22 to 55 years old; defect site: 5 cases of mandibular defect located in body and ascending branch, 4 cases of unilateral angle, 4 cases of bilateral and mental involvement. The maximum defect was 11 cm, with soft tissue defect in 5 cases. The repair methods were as follows: there were 8 cases of free rib graft with internal thoracic artery and vein as donor vessel and 5 cases of rib free graft with intrathoracic artery and vein as donor vessel. The fifth rib cartilage was selected as bone source. In 8 patients with selective facial arteriovenous stenosis, 4 patients with superior thyroid artery and 1 patient with superficial temporal arteriovenous artery were selected. Results: 1. In the left 17 cases, 15 cases of the internal thoracic artery originated directly from the subclavian artery, accounting for 88.2% of the artery and other arteries in 2 cases. The right 17 cases (16 cases) originated from the subclavian artery (94.1%) and 1 case came out of the trunk with other arteries. 2. The internal thoracic artery perforating artery often occurs from the medial wall of the internal thoracic artery. The most common occurrence rate of the anterior perforating branch is 1-4 perforating branch, the occurrence rate is 100%, and the diameter is relatively large, and there is abundant vascular anastomosis between each perforating branch. Most of the accompanying veins perforating the artery are one. 3. When the perforating artery originates from the internal thoracic artery, it can be shallowly through the intrathoracic fascia, intercostal muscle, intercostal fascia and pectoralis major. There is a certain deviation between the shallow source and the starting point. 4. Each branch of perforating artery had a relatively concentrated area. The central area of the second perforating artery was in the second and third costal space, the central distribution of the third perforating artery was in the third and fourth costal space, and the central distribution of the 4th perforating artery. In the fourth and fifth intercostal spaces, the donor region corresponding to perforating vessels can be determined. 5.13 cases of vascularized free rib flap\ bone myocutaneous flap all survived, no infection or necrosis, no vascular crisis. Conclusion: 1. The incidence of intercostal perforating branching artery of internal thoracic artery was the most constant in 2 ~ 3 ~ 4 perforating branch, and the diameter of the perforating branch was thicker, so it was suitable for vascular anastomosis. Vascular anastomosis should select the first end of the perforating branch of the intrathoracic blood vessel. When making the flap, the subdermal vascular network can be preserved and some adipose tissue can be repaired. 2, the upper and lower region of the anterior thoracic area flap is the intercostal and the next intercostal region of the perforating branch. 3. For the patients with oral and mandibular composite tissue defect, rib composite flap pedicled with intrathoracic vessels is an ideal repair method.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R322

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