本文關(guān)鍵詞： 胸大肌 肌皮瓣 應(yīng)用解剖學(xué) 胸外側(cè)神經(jīng) 鎖骨　出處：《大連醫(yī)科大學(xué)》2005年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:關(guān)于胸大肌島狀肌皮瓣轉(zhuǎn)移過程的應(yīng)用解剖學(xué)研究報(bào)道很少。隨著功能外科的發(fā)展,肌皮瓣轉(zhuǎn)移過程中減少副損傷以及對(duì)供區(qū)的形態(tài)與功能的保護(hù)日益受到重視。本課題通過對(duì)胸大肌島狀肌皮瓣轉(zhuǎn)移過程的應(yīng)用解剖學(xué)研究,掌握支配胸大肌鎖骨部的神經(jīng)的解剖學(xué)特點(diǎn),明確胸大肌島狀肌皮瓣的主要血管蒂與鎖骨部神經(jīng)的解剖學(xué)關(guān)系。在胸大肌島狀肌皮瓣轉(zhuǎn)移過程中,尋求新的可行性轉(zhuǎn)移方式,能有效避免鎖骨部的神經(jīng)損傷、保護(hù)胸大肌鎖骨部的形態(tài)與功能。為臨床上合理、安全、方便地使用胸大肌島狀肌皮瓣修復(fù)頭面、頸肩部的組織缺損提供解剖學(xué)依據(jù)。 方法:1、解剖學(xué)研究: 采用巨微解剖學(xué)方法,隨機(jī)選取 30具國人人體標(biāo)本行雙側(cè)解剖。(1)胸大肌鎖骨部的解剖學(xué)特點(diǎn)和三角肌胸大肌間隙處的內(nèi)部特點(diǎn)觀察并記錄。(2)位于胸小肌上緣的胸肩峰動(dòng)脈暴露出來,支配鎖骨部的神經(jīng)被解剖出來, 觀測(cè)并記錄支配胸大肌鎖骨部神經(jīng)的起始、走行和分支分布情況。(3)支配胸大肌鎖骨部的神經(jīng)與胸肩峰動(dòng)脈的胸肌支的空間關(guān)系被觀測(cè)并記錄。2、隨機(jī)選取 6 具國人人體標(biāo)本行模擬島狀肌皮瓣轉(zhuǎn)移手術(shù)實(shí)驗(yàn), 分別在血管蒂起始處的內(nèi)側(cè)經(jīng)鎖骨上、下轉(zhuǎn)移肌皮瓣,在血管蒂起始處的外側(cè)經(jīng)鎖骨上轉(zhuǎn)移肌皮瓣。(1)比較三種轉(zhuǎn)移方式的有效修復(fù)范圍和肌肉血管蒂的有效長度。(2)描繪各自轉(zhuǎn)移特點(diǎn),觀察并記錄副損傷情 2 況和肌皮瓣及其肌肉血管蒂對(duì)鎖骨部神經(jīng)的影響情況。3、數(shù)據(jù)結(jié)果 采用 SPSS10.0 統(tǒng)計(jì)學(xué)軟件處理并分析。 結(jié)果:1、解剖學(xué)研究結(jié)果:(1) 胸大肌鎖骨部肌腹長度為 12.6±1.3cm, 起始部位寬厚分別為 5.8±0.8cm 和 0.9±0.1cm, 止端的 寬厚 分別為 4.8±0.2cm 和 0.7±0.1cm。胸大肌三角肌間溝內(nèi)無神經(jīng)跨越。頭 靜脈沿胸大肌三角肌間溝區(qū)筋膜深面上行。(2)胸外側(cè)神經(jīng)的“1 支 型”分支和“2、3 支型”分支中的第一個(gè)分支即為支配胸大肌鎖骨部 的神經(jīng)。該神經(jīng)從臂叢發(fā)出后向下外走行,于鎖骨后方,鎖骨下肌深 面到達(dá)胸部。神經(jīng)經(jīng)鎖骨下至胸部時(shí)與鎖骨下緣相交體表投影點(diǎn)距同 側(cè)胸鎖關(guān)節(jié)的距離為 6.28±0.73cm( ±s,n=60)。(3)支配胸大肌 鎖骨部的神經(jīng)從鎖胸筋膜穿出的位置位于胸肩峰動(dòng)脈的胸肌支起始處 的顱內(nèi)側(cè),神經(jīng)分支的走行均位于血管蒂的淺層,血管走行的內(nèi)側(cè)。 大部分神經(jīng)的分支進(jìn)入肌肉的部位分布于血管蒂的內(nèi)側(cè)區(qū)域。2、模 擬手術(shù)實(shí)驗(yàn)結(jié)果。(1)血管蒂起始處的內(nèi)側(cè)經(jīng)鎖骨下轉(zhuǎn)移方式其有 效修復(fù)范圍和肌肉血管蒂的有效長度均較其它二種方式大,但是組織 副損傷和神經(jīng)捻挫機(jī)率也大。(2)血管蒂起始處的內(nèi)側(cè)經(jīng)鎖骨上轉(zhuǎn) 移,其有效修復(fù)范圍偏向內(nèi)側(cè),肌肉血管蒂的有效長度與沿血管蒂起 始處的外側(cè)經(jīng)鎖骨上轉(zhuǎn)移相比無顯著性差異。神經(jīng)捻搓和副損傷機(jī)率 大。(3)沿血管蒂起始處的外側(cè)經(jīng)鎖骨上轉(zhuǎn)移,無神經(jīng)副損傷,血 管蒂跨過鎖骨時(shí)的突出程度減輕,肌皮瓣和血管蒂與該神經(jīng)不發(fā)生牽 拉捻挫現(xiàn)象。 結(jié)論:1、胸大肌鎖骨部從肌構(gòu)筑學(xué)上具有提供較大的力量和速 度的潛力。肌皮瓣轉(zhuǎn)移過程中應(yīng)避免損傷支配該部位的神經(jīng),以避免 該部位失神經(jīng)支配而喪失功能。2、胸外側(cè)神經(jīng) “1 支型”分支和 “2、3 支型”分支中的第一個(gè)分支即為支配胸大肌鎖骨部的神經(jīng)。神 經(jīng)經(jīng)鎖骨下至胸部時(shí)與鎖骨下緣相交體表投影點(diǎn)距同側(cè)胸鎖關(guān)節(jié) 6.28+0.73cm 至 6.28-0.73cm 的范圍為該神經(jīng)的手術(shù)操作危險(xiǎn)區(qū)。3、 在解剖研究基礎(chǔ)上,由于支配胸大肌鎖骨部的神經(jīng)的大部分神經(jīng)分支 位于血管蒂的淺層、內(nèi)側(cè),所以在血管蒂起始部位外側(cè),通過三角肌 胸大肌間溝經(jīng)鎖骨上轉(zhuǎn)移島狀肌皮瓣的方法,能有效的避免鎖骨部神
[Abstract]:Objective: to report about applied anatomy of pectoralis major myocutaneous flap transfer process. With the development of surgery rarely function, protect the muscle flap transfer to reduce collateral damage in the process as well as the shape and function of supply site has received increasing attention. This topic through the application of the anatomic study of the pectoralis major myocutaneous flap transfer process, the anatomical features of the master control of theclavicular part of the pectoralis major muscle nerve, anatomical relationship between vascular pedicle and clavicular nerve clear pectoralis major myocutaneous flap. The pectoralis major myocutaneous flap in the process of seeking feasible new transfer mode, can effectively avoid the nerve injury of the clavicular part of the form with the function of protecting the clavicular part of pectoralis major. For clinical reasonable, safe, convenient use of pectoralis major myocutaneous flap to repair the head, to provide anatomical basis for the shoulder and neck tissue defect.
Methods: 1 anatomic study: microsurgical anatomy method, randomly selected 30 Chinese human specimens were dissected. (1) the anatomical features of deltoid and pectoralis major muscle at theclavicular part of the pectoralis major muscle internal characteristics were observed and recorded. (2) is located on the edge of the pectoralis minor chest shoulder peak artery exposed, dominating the clavicular part of the nerve were dissected out and start observing and recording the dominant clavicular part of pectoralis major muscle nerve, walking and distribution. (3) dominated theclavicular part of the pectoralis major muscle and nerve of thoracoacromial artery pectoral branches of the spatial relationship between the observation and recording.2, randomly selected in 6 cadavers the human body specimens simulating island flap transfer surgery experiment, respectively in the vascular pedicle at the start of the medial clavicle, transfer flap, lateral vascular pedicle at the start of the supraclavicular myocutaneous flaps (1). The effective range of three kinds of repair and muscle transfer The effective length of the meat vessel pedicle. (2) depict the characteristics of each metastasis, observe and record the injury of the secondary lesion
Two
The effect of myocutaneous flap and its muscular vessel pedicle on the nerve of the clavicle.3, data results
SPSS10.0 statistical software was used to deal with and analyze.
Results: 1. The anatomical results were as follows: (1) the length of the muscle belly of the clavicle of the pectoralis major muscle was
12.6 + 1.3cm, the width of the initial site was 5.8 + 0.8cm and 0.9 + 0.1cm, and the width of the end was wide.
There were no nerve leaping in the inter deltoid ditches of the pectoralis major muscle of 4.8 + 0.2cm and 0.7 + 0.1cm., respectively.
The veins are along the deep fascia of the deltoid deltoid region of the pectoralis major muscle. (2) "1 branches of the lateral thoracic nerve.
The first branch of the branch and the "2,3 branch" branch is the clavicle of the pectoralis major muscle
The nerve. The nerve goes down from the brachial plexus down, behind the clavicle, and the subclavian muscle is deep.
Arrive the chest. Nerve subclavian to the chest and the lower edge of the clavicle with intersecting surface projection point
The distance of the side thoracic lock joint was 6.28 + 0.73cm (+ s, n=60). (3) dominating the pectoralis major muscle
The position of the nerve of the clavicle from the latch fascia is located at the beginning of the thoracic muscle branch of the thoracic acromion artery.
The inside of the cranium, the branches of the nerve are located in the superficial layer of the pedicle of the vessel, and the blood vessels walk on the inside.
Most of the branches of the nerve enter the part of the muscle and distribute in the medial region of the vascular pedicle,.2.
The results of a quasi operative experiment. (1) the medial subclavian transfer of the pedicle at the pedicle of the vascular pedicle
The effective length of the repair and the effective length of the pedicle of the muscle vessels are larger than those of the other two methods, but the tissue
The rate of secondary injury and nerve twisting is also great. (2) the medial supraclavicular transfer of the pedicle at the pedicle of the vessel
The effective repair range is on the medial side, the effective length of the pedicle of the muscle vessel and the pedicle of the vascular pedicle
There is no significant difference in the lateral subclavicular metastasis of the beginning. The probability of nerve twisting and accessory injury
(3) the lateral passage of the clavicle along the lateral part of the pedicle of the vascular pedicle without nerve and accessory injury.
The protrusion of the pedicle relieved when the clavicle crossed the clavicle, and the musculocutaneous and vascular pedicles were not associated with the nerve.
Twisting and twisting.
Conclusions: 1, the clavicle of the pectoralis major muscle provides greater strength and speed from the muscular architecture.
The potential of the musculocutaneous flap should be avoided during the process of myocutaneous flap transfer.
The loss of function.2, the "1 type" branch of the lateral thoracic nerve and the branching of the lateral thoracic nerve.
The first branch of the "2,3 branch" branch is the nerve that dominates the clavicle of the pectoralis major muscle.
The subclavian to the chest with the ipsilateral clavicle intersects the surface projection point of sternoclavicular joint
The range of 6.28+0.73cm to 6.28-0.73cm is the risk area of.3 for the operation of the nerve.
On the basis of anatomical studies, most of the nerve branches of the nerve of the clavicular part of the pectoralis major muscle are controlled.
It is located in the superficial layer of the vascular pedicle, inside, so in the lateral of the pedicle of the vascular pedicle through the deltoid
The intermuscular ditches through the clavicle transfer the island - like myocutaneous flap to effectively avoid the clavicle.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2005
【分類號(hào)】：R622;R322

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 易偉;翦新春;;胸鎖乳突肌皮瓣修復(fù)口腔頜面部腫瘤術(shù)后缺損的臨床研究[J];醫(yī)學(xué)信息(上旬刊);2011年02期

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本文編號(hào)：1479796