旋股外侧动脉及其分支类型的数字解剖学研究  

Digital anatomical study of the lateral circumflex femoral artery and its branching patterns

作　　者：张兴 吴攀峰[2] 李诚 周小兵 唐举玉[2] Zhang Xing;Wu Panfeng;Li Cheng;Zhou Xiaobing;Tang Juyu(Department of Hand and Microsurgery,Pingdingshan Zhanhe Orthopedics Hospital,Pingdingshan 467000,Henan Province,China;Department of Orthopedic,Hand and Microsurgery,Xiangya Hospital,Central South University,Changsha 410008,Hunan Province,China;Human Morphology Experimental Center,Hengyang Medical School,University of South China,Hengyang 421001,Hunan Province,China)

机构地区：[1]平顶山市湛河骨伤科医院手显微外科,河南平顶山467000 [2]中南大学湘雅医院骨科-手显微外科,湖南长沙410008 [3]南华大学衡阳医学院人体形态实验中心,湖南衡阳421001

出　　处：《中国临床解剖学杂志》2024年第5期535-542,共8页Chinese Journal of Clinical Anatomy

基　　金：国家自然科学基金(81871577);骨科-国家临床重点专科建设经费(Z047-01)。

摘　　要：目的为股前外侧穿支皮瓣的设计与切取提供血管解剖学依据。方法新鲜成人尸体34具行全身血管造影灌注、CT扫描、三维重建、标本解剖与统筹分析,观测旋股外侧动脉的分支、行程与分布区域;然后按照皮瓣的设计、切取步骤,结合三维重建的影像进行解剖验证。结果在65侧有效标本中共观察到大腿前外侧皮肤穿支408支(平均每侧6.3支),其中来源于旋股外侧动脉系统391支,占95.8%(391/408),来源于旋股外侧动脉各分支的占比分别为:升支9.1%(37/408)、横支16.4%(67/408)、降支60.8%(248/408)、斜支9.6%(39/408),其穿支起始部外径分别为(0.7±0.3)、(0.9±0.4)、(1.1±0.5)、(0.8±0.3)mm;来源于股深动脉、旋股内侧动脉、股动脉、旋髂浅动脉17支,占比4.2%,穿支起始部外径为(0.7±0.3)mm。结论(1)旋股外侧动脉降支仍然是股前外侧皮瓣穿支的主要源血管;(2)高位皮肤穿支主要来源于旋股外侧动脉横支与升支;(3)斜支多起源于升支与横支的共干部,具备一定的外径与蒂长,可以斜支为蒂切取皮瓣;(4)旋股外侧动脉来源穿支纤细或缺如时,可以旋股内侧动脉、股动脉等源血管来源的高位皮肤穿支切取皮瓣。Objective To provide vascular anatomical evidence for the design and harvesting of anterolateral thigh perforator flaps.Methods Thirty-four fresh adult cadavers underwent whole-body vascular angiography,CT scanning,3D reconstruction,and specimen dissection for comprehensive analysis.The branches,course,and distribution areas of the lateral circumflex femoral artery were observed.Anatomical validation was then performed in accordance with the design and harvesting steps of the flap surgery,using 3D reconstructed images.Results A total of 408 anterolateral thigh skin perforators were observed in 65 effective specimens(an average of 6.3 per side),of which 391 originated from the lateral circumflex femoral artery system,accounting for 95.8%(391/408).The distribution among the branches of the lateral circumflex femoral artery was as follows:ascending branch 9.1%(37/408),transverse branch 16.4%(67/408),descending branch 60.8%(248/408),and oblique branch 9.6%(39/408).The external diameters of the perforator origin were(0.7±0.3)mm,(0.9±0.4)mm,(1.1±0.5)mm,and(0.8±0.3)mm,respectively.Seventeen perforators originated from the deep femoral artery,medial circumflex femoral artery,femoral artery,or superficial circumflex iliac artery,accounting for 4.2%,with an external diameter of(0.7±0.3)mm at the origin.Conclusions(1)The descending branch of the lateral circumflex femoral artery remains the primary source vessel for anterolateral thigh perforator flaps.(2)High-level skin perforators mainly originate from the transverse and ascending branches of the lateral circumflex femoral artery.(3)Oblique branches often originate from the common trunk of the ascending and transverse branches,possess a certain external diameter and pedicle length,and can be used as the pedicle for flap harvesting.(4)In cases where the perforators originating from the lateral circumflex femoral artery are thin or absent,flaps can be harvested from high-level skin perforators originating from the medial circumflex femoral artery,femoral artery,or othe

关 键 词：股前外侧皮瓣 旋股外侧动脉 三维重建 数字解剖学 穿支皮瓣 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]