改良鼻烟窝皮瓣的应用解剖学研究与临床应用

发布时间：2018-10-07 19:23

【摘要】： 目的：本实验观察了桡神经浅支在鼻烟窝区的走行及其与头静脉的毗邻关系；桡动脉鼻烟窝段的形态及其分支的起始点到桡骨茎突的情况,并以此为基础,探讨应用改良鼻烟窝皮瓣治疗腕手部桡侧皮肤软组织缺损的手术方法。方法：采用经福尔马林常规固定的成尸上肢手标本40侧(男18例、女2例),部分经红色乳胶灌注,常规解剖并观察头静脉、桡神经浅支的毗邻情况；桡神经浅支分支走行及变异情况；桡动脉鼻烟窝段的形态及其分支的起始点到桡骨茎突的情况。用游标卡尺测量桡神经浅支分内外侧支处到桡骨茎突的距离；桡动脉鼻咽窝段长度、近侧端和远侧端的外径,测量该动脉恒定分支腕背支和拇指背动脉发出点位置距桡骨茎突距离；桡动脉茎突返支起始点距桡骨茎突距离。并以此为基础,以桡骨茎突为旋转点设计改良鼻烟窝皮瓣,临床应用治疗腕手部桡侧皮肤软组织缺损18例。结果：桡神经浅支于桡骨茎突上5.14±0.12cm处分为内外侧支,未发现三支、变异者,桡动脉鼻烟窝段长度为2.50±0.18cm,其近侧端和远侧端的外径分别为2.60±0.10mm和2.20±0.13mm。该段桡动脉恒定分支为腕背支和拇指背动脉,腕背支起自主干的尺侧,在桡骨茎突下方1.20±0.11cm处发出；拇指背动脉起于该动脉的外侧壁,在桡骨茎突下方1.50±0.12cm处发出。此二分支发出高度均较恒定。桡动脉茎突返支起始点距桡骨茎突距离为1.20±0.20cm,该支恒定发出。以上述解剖结构为基础,以桡骨茎突为旋转点设计改良鼻烟窝皮瓣,临床应用治疗腕手部桡侧皮肤软组织缺损18例,皮瓣全部成活,1例出现远端部分表皮坏死,经换药后愈合,皮瓣质地柔软,血运良好。结论：应用改良鼻烟窝皮瓣治疗腕手部桡侧皮肤软组织缺损具有操作简便、安全、质地薄,无需再次整形等优点,较传统的鼻烟窝皮瓣扩大了修复的面积,是一种较好的修复方法。
[Abstract]:Objective: to observe the route of the superficial branch of radial nerve in the nasopharyngeal fossa and its relationship with the cephalic vein, the morphology of the nasopharyngeal fossa of the radial artery and the origin of the branch to the styloid process of the radius. To explore the surgical method of modified nasopharyngeal fossa flap in the treatment of radial skin and soft tissue defect of wrist and hand. Methods: 40 hand specimens (18 males and 2 females) of cadaveric upper limbs fixed by formalin were perfused with red latex, and were dissected by routine anatomy and observed the adjacent situation of the superficial branch of radial nerve and cephalic vein. The course and variation of the branches of the superficial branch of the radial nerve, the morphology of the snuff fossa of the radial artery and the origin of the branch to the styloid process of the radius. Vernier caliper was used to measure the distance from the mediolateral branch of the superficial branch of the radial nerve to the styloid process of the radius, the length of the nasopharyngeal fossa of the radial artery, and the external diameter of the proximal and distal ends of the radial nerve. The distance from the point of origin of the dorsal carpal branch and the dorsal thumb artery to the styloid process of the radius and the distance from the origin of the recurrent branch of the styloid process of the radial artery to the styloid process of the radius were measured. On this basis, the modified nasal fossa flap was designed with the radial styloid process as the rotation point. 18 cases of wrist and hand radial skin and soft tissue defect were treated clinically. Results: the superficial branch of radial nerve was dissected to the lateral and lateral branches of the styloid process of the radius by 5.14 卤0.12cm. The length of the nasal fossa of the radial artery was 2.50 卤0.18 cm, and the external diameters of the proximal and distal ends were 2.60 卤0.10mm and 2.20 卤0.13 mm, respectively. The radial artery is a constant branch of the dorsal carpal branch and the dorsal thumb artery. The dorsal carpal branch is located at the ulnar side of the autonomic trunk, and the dorsal thumb artery originates from the lateral wall of the radial styloid process at 1.50 卤0.12cm below the styloid process of the radius, and the dorsal thumb artery originates from the lateral wall of the radial styloid process. The emission height of these two branches is constant. The distance from the starting point of the recurrent branch of the styloid process of the radial artery to the styloid process of the radius was 1.20 卤0.20 cm. Based on the above anatomical structure, the modified nasopharyngeal fossa flap was designed with the styloid process of the radius as the rotation point. 18 cases of radial skin and soft tissue defects of wrist and hand were treated clinically. All the flaps survived in 1 case with partial epidermal necrosis at the distal end and healed after dressing change. The skin flap is soft in texture and good in blood circulation. Conclusion: the modified nasopharyngeal fossa flap has the advantages of simple operation, safety, thin texture and no need to reform the skin and soft tissue defect of the wrist and hand, and it has expanded the area of repair compared with the traditional nasal smoke fossa flap. It is a better repair method.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322

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