腓血管蒂腓骨嵌合组织瓣设计的解剖学基础  

Anatomical basis for design of the chimeric fibular composite flap based on the peroneal artery

作　　者：谢志平[1] 庄跃宏[2] 郑和平[1] 章一新[3] 梁成[1] 郝攀登[1] 张发惠[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]福建医科大学人体解剖与组织胚胎教研室,福州350108 [3]上海交通大学医学院附属第九人民医院整复外科,上海200011

出　　处：《中国临床解剖学杂志》2014年第3期259-263,共5页Chinese Journal of Clinical Anatomy

基　　金：福建省自然科学基金(2012J01410)

摘　　要：目的：为腓血管蒂腓骨嵌合组织瓣设计提供解剖学依据。方法用30侧成人下肢标本，以腓骨头和外踝为标志，将小腿分为上、中、下3区段解剖观测：①腓动脉起源、走行与分支；②腓动脉各区段肌（隔）穿支、骨膜支数目与分布。另1侧新鲜标本摹拟手术设计。结果腓动脉源于胫后动脉，移行为跟外侧动脉，中下段贴腓骨后面走行，沿途分支至邻近骨、肌肉和小腿外侧皮肤。其中：①腓骨骨膜支：（2-8）支、外径0.5-1.1 mm，分布腓骨中下1/3段骨膜：②胫骨骨膜支：（1-3）支、外径0.6-0.8 mm，营养胫骨中、下1/3段后面骨膜；③肌（隔）穿支：（4-8）支、外径1.0-1.6 mm，支配小腿外侧中下段皮肤，并与胫前、胫后动脉皮支吻合。结论以腓动脉为蒂可设计腓骨嵌合组织瓣，依需要选择一种或多种嵌合组织瓣修复骨合并软组织缺损。Objective To provide anatomical basis for design of the chimeric fibular composite flap based on the peroneal artery. Methods 30 cadaveric lower extremities were used for this study. The fibular head and the lateral malleolus were used as the landmarks and the calves were divided into the upper, middle and lower segments, respectively. Dissection of the calves was carried out and the following contents were investigated： ① The origin, course and branches of the peroneal arteries; ② The number of the musculocutaneous or septocutaneous perforators of the three segments and the periosteal branches from the peroneal arteries. Results The peroneal artery originated from the tibial artery and travelled immediately posteriorly to the fibular bone after it coursed to the middle segment of the fibular. It continued as the lateral calcaneal artery, giving off the branches to nourish the adjacent bones, muscles, and the skin on the lateral aspect of the lower leg. Among the branches given off, 2 to 8 branches were to the periosteum of the middle and lower 1/3 of the fibular bone, averaging 0.5 to 1.1 in diameter, which were termed fibular periosteal arteries; 1 to 3 branches were to the middle and lower 1/3 of the tibial periosteum, averaging 0.6 to 0.8 in diameter, which were termed tibial periostal arteries; 4 to 8 branches were the musculocutaneous or septocutnaoues perforators supplying the skin on the lateral aspect of the middle and lower segments of the lower leg. After piercing the deep fascia, the septocutaneous perforators anastomosed with the perforators from the anterior and posterior tibial arteries. Conclusions It is anatomically feasible to harvest the chimeric fibular composite flap based on the peroneal artery, depending on the practical clinical needs;one type or multiple types of chimeric flaps can be harvested to reconstruct combined defects of bone and soft tissue.

关 键 词：腓动脉 腓骨 嵌合组织瓣 穿支皮瓣 

分 类 号：R323.72[医药卫生—人体解剖和组织胚胎学]