前臂掌侧浅静脉网的解剖学特点和临床应用

发布时间：2019-07-05 19:59

【摘要】：目的：1、研究前臂掌侧浅静脉网、手部掌浅弓、指总动脉及指固有动脉的解剖学特点。2、探讨前臂掌测浅静脉网在断掌、多指离断再植中的临床意义。方法：1、尸体标本研究：取20具成人尸体,共40个上肢标本,经乳胶灌注后用福尔马林固定,分别对前臂掌侧浅静脉网的形态特点、管径及瓣膜情况；对掌部的掌浅弓及指总动脉及指固有动脉的位置、大体形态、管径情况进行解剖学观察和统计分析。2、临床应用：手掌严重挤压伤致手掌浅弓、掌深弓损伤,手指血供障碍,应用前臂掌侧浅静脉网移植重建掌浅弓,恢复手指血供。结果：解剖中发现在前臂掌侧皮下的桡、前臂正中、贵要三条知名静脉之间出现的属支及交通支相互交织形成浅静脉网,该处浅静脉的管径(0.5mm～2.3mm)粗细不一,始终可找到与掌浅弓、指总动脉及指固有动脉的形态相匹配而管径(0.8mm～2.7mm)相近似的静脉网,其中尤以前臂掌侧浅静脉网的2、3、4区最为相适,以前臂尺侧浅静脉支较多。临床应用该处浅静脉网移植治疗1例手掌挤压伤致掌动脉弓及其分支动脉和拇指动脉缺损患者,重建掌浅弓及指总动脉,拇指尺侧指固有动脉,手指血运恢复存活。术后随访11个月,按再植术后手功能评定标准,功能恢复良好。结论：前臂掌侧2、3、4区的浅静脉网具有位置表浅,相对丰富,易于切取,供区损伤小的优点,更为重要的是,该处浅静脉属支数量较多,静脉瓣少且形态不完整,属支之间形成的网状结构和不同管径可满足各平面掌浅弓损伤的需要,先重建掌浅弓,其远端再与指总动脉或指固有动脉吻合,重建手指血液循环,减少了血管桥接数量、难度,提高了手术成功率。为严重手掌部动脉毁损伤实施血管移植提供了一个良好而恒定的“移植血管区”。
文内图片：

图片说明：各型断掌的分区情况
[Abstract]:Objective: 1. To study the anatomical characteristics of the superficial palpal venous network of the forearm, the superficial palpal arch of the hand, the common digital artery and the fixed artery of the finger. 2. To explore the clinical significance of the superficial venous network of the forearm palms in replantation of severed palms and severed fingers. Methods: 1. Study on cadaveric specimens: 40 upper limb specimens from 20 adult cadavers were fixed with formalin after latex perfusion. The morphological characteristics, diameter and valve condition of superficial venous network on the palpal side of forearm were analyzed. Anatomical observation and statistical analysis were carried out on the position, gross shape and diameter of the superficial palpal arch and common digital artery and the fixed artery of the finger. 2. Clinical application: severe crush injury of the palm resulted in the superficial arch of the palm, the injury of the deep palpal arch, the disturbance of finger blood supply, and the reconstruction of the superficial palpal arch with superficial venous network transplantation of the forearm to restore the blood supply of the finger. Results: in the anatomy, it was found that in the middle of the forearm, the branches and communicating branches of the three well-known veins intertwined with each other to form a superficial venous network. The diameter of the superficial vein (0.5mm~2.3mm) was different, and a venous network similar to the shape of the superficial palpal arch, common artery and finger artery (0.8mm~2.7mm) could always be found. Among them, 2, 3 and 4 areas of the palmar superficial venous network of the forearm were the most suitable, and the ulnar superficial vein branches of the forearm were more. A case of palm artery arch and its branch artery and thumb artery defect caused by palm crush injury was treated with superficial venous network transplantation. the superficial palpal arch and common digital artery were reconstructed, the ulna digital artery of thumb was recovered, and the blood flow of finger was recovered. The patients were followed up for 11 months. According to the evaluation standard of hand function after replantation, the function recovered well. Conclusion: the superficial venous network in area 4 has the advantages of superficial position, relatively abundant, easy to cut and less injury in donor area. More importantly, the number of superficial vein branches is large, the venous flap is few and incomplete, the reticular structure and different diameter between branches can meet the needs of superficial palpal arch injury in each plane, and its distal end is anastomosed with common digital artery or proper digital artery. The reconstruction of finger blood circulation reduces the number and difficulty of vascular bridge, and improves the success rate of operation. It provides a good and constant "vascular transplantation area" for severe palm artery destruction and injury.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R658.2;R322

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