本文關(guān)鍵詞：腓腸內(nèi)側(cè)動(dòng)脈穿支血管的解剖研究與改良腓腸內(nèi)側(cè)島狀肌皮瓣的臨床應(yīng)用　出處：《第二軍醫(yī)大學(xué)》2016年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 腓腸肌島狀皮瓣 腓腸內(nèi)側(cè)動(dòng)脈 穿支血管 脛骨感染 骨外露

【摘要】：目的通過(guò)對(duì)人體解剖學(xué)觀察,研究腓腸內(nèi)側(cè)動(dòng)脈及其穿支血管的解剖學(xué)基礎(chǔ)。將解剖學(xué)數(shù)據(jù)應(yīng)用于臨床,設(shè)計(jì)以腓腸內(nèi)側(cè)動(dòng)脈為血管蒂,并包含穿支血管的改良腓腸內(nèi)側(cè)島狀肌皮瓣,探討改良腓腸內(nèi)側(cè)島狀肌皮瓣對(duì)脛骨近端骨折術(shù)后感染伴鋼板或骨外露在臨床中的應(yīng)用價(jià)值。方法1.選取8側(cè)成人新鮮尸體下肢標(biāo)本,經(jīng)股動(dòng)脈灌注乳膠硫酸鋇溶液,解剖并觀察腓腸內(nèi)側(cè)動(dòng)脈穿支血管的數(shù)目、起始部外徑、穿出點(diǎn)外徑、血管蒂長(zhǎng)、穿支穿出點(diǎn)位置。測(cè)量數(shù)據(jù)采用SPSS軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。然后取2例剝離的體被組織行X線觀察腓腸內(nèi)側(cè)動(dòng)脈及其穿支走行情況。2.回顧性分析2013年1月至2015年6月在我科收治的15例脛骨近端骨折術(shù)后感染伴鋼板或骨外露患者,其中男9例,女6例,年齡24~58歲,平均35.6歲,左側(cè)10例,右側(cè)5例。致傷原因:交通事故傷10例,重物砸傷3例,機(jī)械損傷2例。其中GustiloⅠ型12例,GustiloⅡ型3例,入院前均一期或分期實(shí)施了骨折復(fù)位內(nèi)固定術(shù),術(shù)后因皮膚軟組織壞死感染而出現(xiàn)骨或內(nèi)固定外露,外露時(shí)間11天~74天,平均34天。入院后術(shù)前創(chuàng)面分泌物細(xì)菌培養(yǎng)結(jié)果為金黃色葡萄球菌10例,銅綠假單胞菌2例,表皮葡萄球菌2例,鮑氏不動(dòng)桿菌1例。在我科采用清創(chuàng)及改良腓腸內(nèi)側(cè)島狀肌皮瓣進(jìn)行治療,皮瓣大小和形狀根據(jù)清創(chuàng)后皮膚軟組織缺損大小與形狀進(jìn)行設(shè)計(jì),其中切取皮瓣面積為3.6 cm×4.2 cm~5.3 cm×6.5 cm,術(shù)后對(duì)皮瓣成活率、并發(fā)癥、膝踝關(guān)節(jié)功能、皮瓣受區(qū)與供區(qū)外觀滿意度進(jìn)行隨訪觀察。結(jié)果1.在8側(cè)成人尸體下肢標(biāo)本上,觀測(cè)腓腸內(nèi)側(cè)動(dòng)脈穿支血管共18支,平均2.3支,其中13支(72.2%)發(fā)自于腓腸內(nèi)側(cè)動(dòng)脈后支,5支(27.8%)發(fā)自于腓腸內(nèi)側(cè)動(dòng)脈前支。穿支穿出點(diǎn)外徑平均為0.87±0.25 mm(0.6 mm~1.1 mm),穿支起始部外徑平均為1.82±0.47 mm(1.3 mm~2.3 mm)。穿支蒂長(zhǎng)為3.2 cm~8.2 cm(平均5.4 cm),血管蒂長(zhǎng)6.5 cm~15.7 cm(平均為11.2cm)。穿支淺出點(diǎn)集中出現(xiàn)在距乆皺褶以遠(yuǎn)7.6 cm~17.8 cm(平均10.9 cm),距后正中線1.3 cm~4.2 cm(平均2.8 cm)的范圍內(nèi)。2.本組15例患者皮瓣均成活,14例一期愈合,1例二期愈合。本組住院時(shí)間12~50天,平均27.3天。15例患者均進(jìn)行了至少6個(gè)月(6~24月)的術(shù)后隨訪,在末次隨訪中,供區(qū)愈合良好,皮膚感覺(jué)功能未見(jiàn)受到影響,皮瓣平整、質(zhì)軟柔和,患者對(duì)受區(qū)及供區(qū)外形滿意。15例患者骨折最后全部愈合,無(wú)骨不連、畸形愈合、骨髓炎發(fā)生,未見(jiàn)明顯膝踝關(guān)節(jié)功能障礙,患者生活及工作未受到明顯影響。根據(jù)改良ASAMI評(píng)分系統(tǒng)評(píng)價(jià)療效:優(yōu)10例,良4例,中1例,差0例。結(jié)論1.腓腸內(nèi)側(cè)動(dòng)脈及其穿支血管較為恒定,腓腸肌內(nèi)側(cè)島狀肌皮瓣切取時(shí)以腓腸內(nèi)側(cè)動(dòng)脈為蒂,并包含穿支血管或攜帶其源動(dòng)脈時(shí),可獲得較為穩(wěn)定血供,是改良腓腸內(nèi)側(cè)島狀肌皮瓣成活的解剖學(xué)基礎(chǔ)。2.改良腓腸內(nèi)側(cè)島狀肌皮瓣能夠一期治療脛骨近端骨折術(shù)后鋼板或骨外露并感染,避免鋼板取出,縮短病程,減輕患者經(jīng)濟(jì)負(fù)擔(dān);且皮瓣具有薄而柔軟,受區(qū)外形美觀,供區(qū)創(chuàng)傷小等優(yōu)點(diǎn)。
[Abstract]:Objective To observe the anatomy, anatomic study of medial sural artery perforator vessels and anatomical data. The clinical application in the design to the medial sural artery as the pedicle, and the improved medial sural island flap perforator, to explore the application value with steel plate or bone exposure in clinical infection in modified medial gastrocnemius island myocutaneous flap of proximal tibial fracture after operation. Methods 1. 8 side of fresh adult lower limb specimens, the femoral artery perfusion barium sulfate latex solution, the number of dissected and observed the medial sural artery perforator, the initial part of the outer diameter of piercing point diameter, long vascular pedicle, piercing point position measurement data for statistical perforating branches. Analysis by SPSS software. Then the body was stripped from 2 cases of tissue X-ray observation of medial sural artery perforator and walking.2. were retrospectively analyzed from January 2013 to June 2015 With steel plate or bone exposure in patients with infection in our hospital from 15 cases of tibial proximal fracture after operation, 9 cases were male, 6 were female, aged 24~58 years old, average 35.6 years old, 10 cases on the left side, right side in 5 cases. The causes of injury: 10 cases of traffic accident injury, 3 cases of bruise, mechanical injury in 2 cases in 12 cases of Gustilo type, 3 cases of type II Gustilo, before admission, one stage or the phased implementation of the fracture reduction and internal fixation, postoperative necrosis of skin and soft tissue infection and internal fixation or bone exposure, exposure time 11 ~74 days, average 34 days after admission. The preoperative germiculture results 10 cases of Staphylococcus aureus in 2 cases, 2 cases of Pseudomonas aeruginosa, Staphylococcus epidermidis, Acinetobacter bacilli in 1 cases. The debridement and improvement of medial sural island flap for treatment, according to the size and shape of flaps after debridement of skin and soft tissue defect size and shape design, including flap 闈㈢Н涓，

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