虎口区皮肤观测及其临床意义  

Observation and clinical significance of skin in the first web space

作　　者：池征璘 曹学新 赵连民 胡伟军 周飞亚[2] 陈一衡[2] CHI Zhenglin;CAO Xuexin;ZHAO Lianmin;HU Weijun;ZHOU Feiya;CHEN Yiheng(Department of Hand Surgery,The Third Hospital of Suqian,Suqian,Jiangsu Province 223800,China;Department of Hand and Microsurgery,The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang Province 325000,China)

机构地区：[1]江苏省宿迁第三医院手外科,江苏宿迁223800 [2]温州医科大学附属第二医院手显微外科,浙江温州325000

出　　处：《中华显微外科杂志》2023年第2期185-189,共5页Chinese Journal of Microsurgery

基　　金：浙江省温州市级基础性科研项目(Y20190020)。

摘　　要：目的基于尸体标本对虎口区皮肤的解剖进行科学的测量和形态学评估,指导虎口区皮瓣的设计。方法2020年3月至2021年12月,江苏省宿迁第三医院手外科选取16例经10%甲醛常规防腐固定、手部无外伤或者畸形的尸体标本,根据虎口区域特征选择虎口区域皮瓣的标志点,确定虎口区皮肤切取标准。对拇指在桡侧外展(r)和掌侧外展(p)这两个体位下虎口区皮肤的各观测指标进行测量。数据采用t检验进行统计学分析,P<0.05为差异有统计学意义,并根据测量结果得出标准化的虎口区皮瓣形状和参数。结果拇指处于掌侧外展位时,女性/男性虎口最大间距[a(p)]为5.78/8.42 cm,虎口区皮肤面积[S(p)]为17.09/23.63 cm^(2);拇指处于桡侧外展位时,女性/男性的虎口间距[a(r)]为4.86/6.28 cm,虎口区皮肤面积[S(r)]为14.39/20.15 cm^(2)。两个体位之间间距和面积的差异有统计学意义(P<0.05)。拇指在两个不同的外展体位下,皮瓣长轴的长度[b(r)]和[b(p)]相比较(分别为7.54/9.38 cm和7.34/9.74 cm),差异无统计学意义(P>0.05)。通过形态学测量发现,虎口区皮肤的形态并非对称的梭形,而是一个偏向示指侧的不规则四边形。结论虎口区域皮瓣的设计和测量要以拇指掌侧最大外展体位时作为参考,非对称的四边形虎口区皮瓣设计更符合该区域解剖形态特点。ObjectiveTo scientifically measure and morphologically evaluate the anatomical shape of the skin in the first web space based on cadavers,and to guide the design of flap in this area.MethodsSixteen human cadavers fixed with 10%formaldehyde without injury or deformity on the hand were selected in the Department of Hand Surgery,the Third Hospital of Suqian.According to the characteristics of the first web area,marker points were selected for measurement and morphological observation.Morphological characteristics of the first web with thumb radial abduction(r)or palmar abduction(p)were measured and compared.The t-test was used for statistical analysis.P<0.05 was considered statistically significant.According to the results of measurement,standardised shapes and parameters of the skin were obtained for flap repair of defect of the first web.ResultsWhen the thumb was in palmar abduction,the maximum distance[a(p)]of the first web of female(F)and male(M)was 5.78/8.42 cm(F/M),and the skin[S(p)]was 17.09/23.63 cm^(2)(F/M),both were significantly greater than the distance[a(r)]at 4.86/6.28 cm and the area of skin area[S(r)]at 14.39/20.15 cm^(2)when thumb was in the radial abduction position(P<0.05).There was no significant difference in the length of[b(r)]and[b(p)]alone the long axis of flap between palmar and radial abductions(7.54/9.38 cm and 7.34/9.74 cm,respectively)of the thumb(P>0.05).It was found that the area of first web was not shaped as a symmetrical spindle,but an irregular quadrilateral inclined to the index finger.ConclusionDesign and measurement of a flap for the first web space should take the maximum palmar abduction of a thumb as a reference.The asymmetric quadrilateral flap design is more in line with the anatomical and characteristics in the region.

关 键 词：虎口 外科皮瓣 测量 形态 应用解剖 

分 类 号：R658.2[医药卫生—外科学]