前锯肌肌瓣移植的应用解剖学研究  

Applied anatomy of the serratus anterior in flap transplantation

作　　者：朱渊[1] 徐向阳[1] 张懿鸣[1] 

机构地区：[1]上海瑞金医院骨科,200025

出　　处：《中华骨科杂志》2007年第7期521-524,共4页Chinese Journal of Orthopaedics

摘　　要：目的研究前锯肌肌瓣移植的应用解剖。方法解剖观测20具（40侧）常规防腐尸体标本的前锯肌形态、面积大小、各部分肌齿在肩胛骨上止点的长度,胸背血管、胸长神经的起源、走行、分支、分布,前锯肌支、胸背动脉、肩胛下动脉的直径,肌瓣的血管蒂长度等。结果（1）前锯肌下部肌齿仅止于肩胛下角,占整个前锯肌垂直附着长度的21%,前锯肌中下部平均面积为8.8cm×12.9cm,中下部平均厚度为（6.0±1.3）mm。（2）前锯肌中下部主要由胸背动脉的前锯肌支供血。前锯肌支、胸背动脉、胸背动脉伴行静脉和肩胛下动脉的平均直径分别为（1.8±0.4）mm,（2.4±0.5）mm,（2.9±0.4）mm和（3.4±0.5）mm。以前锯肌支和胸背动脉为蒂的肌瓣蒂长分别为（4.3±1.1）cm和（9.3±1.3）cm。（3）前锯肌由胸长神经支配。其各部肌齿分别由独立的胸长神经分支支配。胸长神经横向分支数（3.9±1.6）支,末端鸦爪样分支数（4.9±2.6）支。（4）胸背动脉主干、胸长神经主干以及胸背神经的解剖位置恒定。神经、血管均位于前锯肌的中、后1/3处。结论前锯肌肌瓣血管蒂长,解剖位置恒定,切取下部肌齿后上部肌齿的神经支配不受影响。切取前锯肌最下4～5个肌齿,不会影响前锯肌的主要功能。Objective To study the anatomy of serratus anterior muscle and the application of free serratus anterior muscle flap transplantation. Methods Twenty cadaveric specimens were involved in this study, including 15 males, 5 females, with the mean age of 77 years （ranged 68-81 years）, height from 150- 174 cm. The morphology and size of the serratus anterior, the length of the insertion part of the muscle slips, and the origins, lengths, diameters, branches, courses and distributions of the thoracodosal vessels and the long thoracic nerves as well as the length of the pedicle of the muscle flaps were observed and measured on all cadaveric specimens. Results 1 ） The lower portion of the serratus anterior inserted to the inferior angle of the scapula, and occupied the lower 21% of the longitudinal ridge of the scapula. The mean area and thickness of the middle and lower portion of the serratus anterior was 8.8 cm×12.9 cm and （6.0±1.3） mm^2） The lower portion of the serratus anterior was mainly supplied by the serratus anterior branch of the thoracodosa] artery. The diameters of the serratus anterior branch, thoracodosal artery, accompanying vein of thoracodosal artery and subclavicular artery were （1.8±0.4） mm, （2.4±0.5） mm, （2.9±0.4） mm and （3.4±0.5） mm respectively. The length of pedicle of the serratus anterior branch and the thoracodosal artery were （4.3±1.1） cm and （9.3±1.3） cm^ 3） The serratus anterior muscle was innervated by the long thoracic nerve. Each portion of the muscle was innervated by independent branches of the long thoracic nerve. The number of transversal and terminal branches were 3.9±1.6 and 4.9±2.6. 4） The main branches of thoracodosal artery, long thoracic nerve and thoracodosal nerve were fixed at posterior-middle third of serratus anterior. Conclusion The pedicle of the serratus anterior flap is long enough, and the position of the muscle flap and pedi- cle is fixed. The lowest 4-5 slips of the muscle can be obtained, without influence of the mai

关 键 词：外科皮瓣 解剖学 局部 组织移植 

分 类 号：R686[医药卫生—骨科学]