前臂穿支血管在显微层次的解剖学研究  

Study on the stratified microanatomy of forearm perforators vessel

作　　者：郭朝帅 朱明昇 王强 董丽琨 赵祖耀 王春霖 王增涛[1,2] GUO Chaoshuai;ZHU Mingsheng;WANG Qiang(Shandong University,Jinan,Shandong,250100,China)

机构地区：[1]山东大学,山东济南250100 [2]山东第一医科大学附属省立医院手足外科,山东济南250021 [3]潍坊市人民医院手足骨外科,山东潍坊261000

出　　处：《实用手外科杂志》2023年第2期240-244,264,共6页Journal of Practical Hand Surgery

摘　　要：目的解剖观测前臂穿支血管,探究分布规律,为临床上前臂穿支皮瓣精确设计及切取提供解剖学依据。方法成人新鲜前臂标本10侧,红色乳胶灌注动脉。解剖范围:远端至桡腕关节平面,近端至肘关节平面。在手术显微镜下,去除皮肤,用显微器械仔细剔除浅筋膜中的脂肪等组织,解剖游离浅筋膜中穿支血管,记录穿支数目及穿深筋膜位置,观察穿支血管间的吻合情况;在手术显微镜下切开深筋膜,向深部解剖至各穿支起始处,测量其在起始处及穿深筋膜处血管直径。结果前臂皮穿支血管(45.20±5.42)支,以肌间隙穿支为主(85.0%)。肌间隙穿支较为恒定的(93.8%)从5个血管皮穿支间隙穿出:⑴桡掌侧间隙:肱桡肌与桡侧腕屈肌之间(24.2%);⑵尺掌侧间隙:指浅屈肌与尺侧腕屈肌之间(16.4%);⑶尺侧间隙:尺侧腕屈肌与尺侧腕伸肌之间(20.8%);⑷尺背侧间隙:尺侧腕伸肌与小指伸肌之间(15.9%);⑸桡背侧间隙:指伸肌与桡侧腕长、短伸肌之间(16.7%)。同一血管皮穿支间隙内穿支血管沿此间隙纵向形成血管链,与其他血管皮穿支间隙的穿支血管及肌皮穿支形成血管网。结论前臂的5个血管皮穿支间隙是前臂皮瓣主要的设计与切取的轴线。Objective To observe the forearm perforators and explore their distribution pattern,so as to provide an anatomical basis for precise design and excision of forearm perforator flaps in clinical practice.Methods Adult fresh forearm specimen from 10 sides with red latex perfused its artery.From the transverse wrist to the transverse elbow.under the surgical microscope,the skin was removed,and tissues such as fat in the superficial fascia were carefully removed with microsurgical instruments,and perforators in the free superficial fascia were dissected,and the number of perforators and their location in penetrating deep fascia were recorded,and the anastomoses between perforators were observed;The deep fascia was incised under the surgical microscope,dissected deeper to the origin of each perforator,and its vessel diameter at the origin and along the deep fascia was measured.Results Forearm skin perforators were(45.20±5.42)branches,of which the intermuscular space perforators predominated(85.0%).The intermuscular space perforators were more constant(93.8%)penetrating out from the following 5 vascular perforator spaces:(1)Radial volar side space:between brachioradialis and flexor carpi radialis(24.2%);(2)Ulnar volar side space:between flexor digitorum superficialis and flexor carpi ulnaris(16.4%);(3)Ulnar side space:between flexor carpi ulnaris and extensor carpi ulnaris(20.8%);(4)Ulnar dorsal side space:between extensor carpi ulnaris and extensor digitorum brevis(15.9%);(5)Radial dorsal side space:between extensor digitorum and extensor carpi radialis long and short(16.7%).A vascular chain was formed longitudinally along this space by perforators within the same vascular perforator space and formed a vascular network with perforators inother vascular perforator spaces and musculocutaneous perforators.Conclusion Forearm perforators mainly penetrate from 5 vascular perforator spaces that can be used as a long axis for forearm flap design and cutting.

关 键 词：前臂 穿支血管 肌间隙 皮瓣 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R658.2[医药卫生—基础医学]