膝上外侧动脉穿支髂胫束皮瓣的解剖特点与临床应用  

The anatomical characteristics and clinical application of the lateral superior genicular artery perfora- tor iliotibiai band flap

作　　者：高建明 徐达传[2] 储旭东 郭峰 卢绪 骆宇春 刘云鹏 

机构地区：[1]解放军第一○一医院骨科,江苏省无锡市 214044 [2]南方医科大学人体解剖学教研室

出　　处：《中华显微外科杂志》2010年第6期450-453,532,共5页Chinese Journal of Microsurgery

基　　金：广东省科技厅基金资助项目（2KM05505S）：南京军区医药卫生科研基金项目（07M015）

摘　　要：目的 探讨膝上外侧动脉穿支髂胫束皮瓣的解剖学基础与临床应川效果。方法自1999年9月至2009年7月，存40侧经动脉灌注红色乳胶的成人下肢标本上，解剖、观测膝上外侧动脉的起源、走行、分支、分布、吻合以及髂胫束的血供来源，临床应用吻合膝上外侧动脉穿支髂胫束瓣移植5例、髂胫束皮瓣4例。结果80％（35侧）膝上外侧动脉单独起自胭动脉，起始外径（1．8±O．4）mm.该动脉向外蜿蜒上行分为升、降支，从股外侧肌与股二头肌短头肌之间的股外侧肌间隔穿出形成肌间隙（隔）筋膜皮肤穿支，或与膝卜最外侧动脉在股外侧肌内吻合后发出肌皮穿支，供养大腿中下段髂胫束和前外侧皮肤，其中较粗大穿支起始外径（1．0±0．2）mm，并存深筋膜浅层或深层于近端与旋股外侧动脉降支吻合，远端与膝关节网吻合。临床也埔9例，其中修复单纯跟腱缺损5例，跟腱伴皮肤缺损2例：修复小腿、足软组织缺损各1例。随访6个门～7年8个门，带m供髂胫束修复跟腱缺损功能恢复良好，4例髂胫束皮瓣全部成活。结论吻合膝上外侧动脉穿支髂胫束皮瓣是一种新型、简便、实用的复合（软组织）缺损修复方法．适于临床推，“应用．Objective To discuss anatomical characteristics and clinical results of the lateral superior genicular artery perforator illotibial band flap. Methods From September 1999 to July 2009, the origin, course, branches and distribution of the lateral superior genicular artery and blood supply of iliotibial band were observed on 40 sides aduh lower limbs perfused with red latax. Five perforator iliotibial band and 4 perforator iliotibial bamt flaps of 9 cases were treated with anastomosis of lateral superior genicular artery perforating rami. Results The lateral superior genicular arteD- of 35 cases （80%） originates from the popliteal artery. Its originated external diameter was （1.8± 0.4） ram. It divides into ascending branch and descending branch, and they gives off septofaseio-cutaneous peribrator, or anatomoses the lateral uppermost genicular artery in the vastus lateralis muscle,and then formes the museulocutaneous perforator of iliotibial band. The originated external diameter of the larger perforator of iliotibial bands was （1.0 ± 0.2） mm and they provides for the skin and iliotibial band of lateral superior genicular area. Nine cases, including 5 cases of simple Achilles tendon defeets, two cases of achilles tendon defects with skin defects, and 2 eases of lower extremity and foot soft tissue defects were treated with transplantation of the vascularized iliotibial band （flap） with perforator vascular anastomoses. All cases were followed up 6 - 92 months. The results showed significant improvement in ＂heel test＂ and Thompson sign in the recupture of the Achilles tendon occurred. Four perforator iliotibial band flaps survived well. Conclusion The lateral superior genicular artery perforator iliotibial band flap is a practical, simple and new donor in the reconstruction of soft tissue and composite defects.

关 键 词：髂胫束 穿支皮瓣 膝L外侧动脉 显微外科 

分 类 号：R686[医药卫生—骨科学]