腘窝直接动脉穿支蒂股后皮神经营养血管皮瓣的解剖基础  

ANATOMIC BASIS OF POSTERIOR FEMORAL NEUROCUTANEOUS VASCULAR FLAP PEDICLED WITH DIRECT POPLITEAL ARTERY PERFORATOR

作　　者：林加福[1] 陈雪松[2] 林金堆[1] 郑和平[1] 

机构地区：[1]福建医科大学福总临床医学院(南京军区福州总医院)骨科研究所,福州350025 [2]解放军第59医院创伤显微外科

出　　处：《中国修复重建外科杂志》2011年第4期419-422,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：福建省自然科学基金资助项目(2009J01183)~~

摘　　要：目的探讨腘窝直接动脉穿支蒂股后皮神经营养血管皮瓣的解剖学基础。方法于30侧动脉内灌注红色乳胶的成人下肢标本上解剖观测:股后皮神经走行与分布;腘窝直接动脉穿支与股后皮神经营养血管间吻合关系。另在1侧新鲜成人下肢标本上进行摹拟手术设计。结果股后皮神经主干由臀大肌下缘中点穿出入股后部,主干沿股后正中线下行,终支伴小隐静脉下降,达小腿后面中部。其在穿臀大肌下缘和腘窝上角处横径分别为(3.0±0.6)mm和(2.0±0.7)mm。其营养血管为多节段、多源性,其中腘窝直接动脉穿支的位置相对恒定,于膝关节平面上7～11cm处,起于腘动脉上段后壁,起点外径(0.8±0.2)mm,伴行静脉1～2条。该动脉为股后皮神经下段主要血供来源,上行过程中发出5～8支皮支与股深动脉(第1～3穿动脉)皮穿支、闭孔动脉穿支和旋股外侧动脉皮穿支吻合,在股后形成顺沿中线和股后皮神经纵轴的血管丛。摹拟手术结果显示可形成腘窝直接穿支蒂股后皮神经营养血管皮瓣。结论腘窝直接动脉穿支蒂股后皮神经营养血管皮瓣血供相对恒定、手术操作简便,移位后可用于修复腘窝及膝周软组织缺损。Objective To provide the anatomical basis for posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator.Methods A total of 30 embalmed lower limbs of adult cadavers perfused with red latex were dissected and measured to observe the course and distribution of posterior femoral cutaneous nerve（PFCN）,and the anastomoses between direct popliteal artery perforator and nutrient vessels of PFCN.Mimic operation was performed on 1 side of fresh specimen.Results PFCN started from the midpoint of the inferior gluteus maximus edge,and went down along the middle line of posterior thigh region,and the final trunk of PFCN accompanied with small saphenous vein down to the middle line of lower leg.The diameters of PFCN was（3.0 ± 0.6） mm at the inferior gluteus maximus edge,and was（2.0 ± 0.7） mm at the superior fossa poplitea.The nutrient vessels of PFCN were multi-segmental and polyphyletic.The direct popliteal artery perforator which started from popliteal artery directly was constant pierced into deep fascia about 7-11 cm above the knee joint,and its original diameter was（0.8 ± 0.2） mm.The direct popliteal artery perforator had 1-2 accompanying veins,and this perforator artery was the main nutrient vessel of the inferior segment of PFCN.The direct popliteal artery perforator gave off 5-8 small vessels which anastomosed with the 1st-3rd perforator of deep femoral artery,the obturator artery perforator,and the lateral femoral circumflex artery perforators.Then these nutrient vessels formed vascular plexus along PFCN in the middle line of posterior region of thigh.Mimic operation showed that the posterior femoral neurocutaneous vascular flap pedicled with direct poplitea artery perforator could be formed successfully.Conclusion The posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator has constant blood supply and can be easily formed to repair defects around knee joint.

关 键 词：腘窝直接动脉穿支 股后皮神经 皮神经营养血管皮瓣 修复 应用解剖 

分 类 号：R684[医药卫生—骨科学]