穿支血管蒂腓肠神经营养血管皮瓣的实验研究  

STUDY ON ANIMAL MODEL OF PERFORATOR SURAL NEUROCUTANEOUS FLAP

作　　者：文根[1] 柴益民[1] 汪春阳[1] 吴旭华[1] 王磊[1] 成亮[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中国修复重建外科杂志》2010年第4期458-461,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的建立穿支血管蒂腓肠神经营养血管皮瓣的实验动物模型,为皮瓣生理及血流动力学的研究提供基础。方法新西兰大白兔35只,雌雄不限,体重2.5～3.0kg,根据观察方法不同随机分为4组。活体解剖观察组5只10侧,解剖观察腓肠神经、伴行血管、胫后动脉及穿支血管走行。乳胶灌注观察组和明胶-氧化铅灌注解剖X线片观察组,分别5只10侧,两组动物处死后分别经腓肠神经伴行动脉或胫后动脉注入乳胶或明胶-氧化铅,观察上述血管走行、直径及吻合情况。皮瓣移位观察组20只40侧,设计以胫后动脉跟骨上穿支血管为蒂,腓肠神经走行为轴线的远端蒂皮瓣,皮瓣面积为7cm×1cm,蒂长0.5cm,观察皮瓣颜色和肿胀情况。结果腓肠神经起源于胫后神经,于腘窝部穿腓肠肌外侧头斜行向外下走行,于外踝上(5.42±0.15)cm处穿至深筋膜下,垂直走向外踝,其伴行动脉起源于股深动脉,起始直径为(0.73±0.11)mm,伴行腓肠神经行向外踝。胫后动脉跟骨上穿支血管起始于内踝与跟骨连线中点,起始直径(0.45±0.01)mm。穿支血管于跟骨上方行至外踝区与腓肠神经伴行血管相吻合,共同构成腓肠神经周围血管网。2侧皮瓣因术后感染排除实验,其余38侧皮瓣术后10d成活率为78.0%±1.5%。结论兔穿支血管腓肠神经营养血管远端蒂皮瓣解剖稳定,切取简便,血管可靠,是良好的研究穿支蒂皮神经营养血管皮瓣的动物模型。Objective To establish the experimental animal model of perforator sural neurocutaneous flap for laying a foundation of further study on its physiology and haemodynamics.Methods Thirty-five New Zealand rabbits were divided into four groups,weighing 2.5-3.0 kg and being male or female.In group A（n=5）,vivisection was performed to observe the starting point and arrangement of sural nerve,its concomitant vessels,posterior tibial artery and perforating vessel.In groups B and C（n=5）,red latex and gelatin-lead oxide were injected into the concomitant arteries of sural nerve and the posterior tibial arteries respectively to observe their arrangement,the diameter and anatomasis.In group D,forty neurocutaneous flaps based on single perforator were elevated in the twenty rabbits with a size of 7 cm×1 cm and a pedicle of 0.5 cm.The colour and condition of flaps were observed.Results The sural nerve originated from posterior tibial nerve,passed through the lateral head of the gastrocnemius at site of the popliteal fossa,descended obliquely to exterior,entered in the deep fascia at about（5.42±0.15）cm above lateral malleolus,and descended vertically to lateral malleolus.Its concomitant artery originated from deep femoral artery with an initial diameter of（0.73±0.11）mm and extended to the lateral malleolus along the sural nerve.A perforating branch of posterior tibial artery at the position of the calcaneus originated from the midpoint of the line connecting between the medial malleolus and the calcaneus with an initial diameter of（0.45±0.01）mm.The perforating branch traversed the calcaneus to the region of the lateral malleolus,and anastomosed to the concomitant artery of the sural nerve,forming a vascular plexus around the sural nerve.In group D,two cases were excluded due to infection.The survival rate was 78.0%±1.5%in other 38 flaps 10 days after operation.Conclusion The perforator based sural neurocutaneous flap in rabbit is a good experimental model,which has stable anamatic features and reliable b

关 键 词：穿支血管蒂腓肠神经营养血管皮瓣 动物模型 兔 

分 类 号：R658.3[医药卫生—外科学]