本文選題：前臂　切入點：橈動脈　出處：《福建中醫(yī)藥大學》2010年碩士論文　論文類型：學位論文

【摘要】： 目的通過研究前臂橈動脈穿支血管的解剖學特點,為前臂橈動脈穿支皮瓣的設計及臨床應用提供解剖學依據(jù),為修復手部創(chuàng)面及功能重建提供方法,并報道初步臨床應用效果。 方法①18側(cè)紅色乳膠灌注的成人上肢標本,以橈骨莖突為觀測標志點,重點顯微解剖前臂下1/3段,對前臂橈動脈的主要血管分布及其吻合,前臂橈動脈及其發(fā)出的穿支血管行顯微解剖(放大5倍),并觀察它們的起始、管徑、走行、分支及分布情況。②從2008年6月至2010年1月,運用前臂橈動脈穿支皮瓣修復手部創(chuàng)面及手部功能重建,同時術(shù)后應用中藥：活血止痛湯治療5例。 結(jié)果前臂橈動脈發(fā)出的穿支血管約14支,近側(cè)段數(shù)目較少(平均3支)但口徑較大,遠側(cè)段數(shù)目較多(平均11支)但口徑較小,在上1/3處發(fā)出1～3支肌穿支,中1/3處發(fā)出2～3支穿支,下1/3處發(fā)出3～7支穿支。橈動脈兩側(cè)發(fā)出的穿支外徑(0.7±0.4)mm,各穿支動脈發(fā)出分支沿縱行方向相互吻合。橈動脈主要穿支血管：①橈動脈背側(cè)淺支：穿過肱橈肌腱后于其外側(cè)下降,起點距橈骨莖突上(7.0±1.1)cm,起始外徑(0.6±0.3)mm,并分為細短的升支和粗長的降支；②橈動脈掌淺支：橈動脈于前臂下1/3段近腕橫紋處發(fā)出掌淺支,起點距橈骨莖突上(1.5±1.0)cm,起始外徑(1.5±0.2)mm,長(2.3±1.0)cm；③橈骨莖突返支：于鼻煙窩內(nèi),橈動脈或腕背支近端發(fā)出橈骨莖突返支1～2支,起點距橈骨莖突(0.5±0.3)cm,長(1.0±0.5)cm,起始外徑(0.8±0.1)mm。莖突返支分莖突骨膜支、穿支及頭靜脈營養(yǎng)血管,起始外徑(0.5±0.2)mm；④橈動脈鼻煙窩支：橈動脈從橈骨莖突的遠端斜向外下,行于拇長展肌腱和拇短伸肌腱的深面。在橈動脈鼻煙窩近段,或由其腕背支的近端發(fā)出穿支1～2支,起點距橈骨莖突下(1.2±0.3)cm,外徑(0.6±0.1)mm；⑤動脈骨皮穿支：在距橈骨莖突上(8.0～16.0)cm之間,橈動脈肌間隙骨皮穿支1～3支,起始外徑(1.2±0.2)mm。臨床運用于5位患者術(shù)后均常規(guī)服用活血止痛湯,病例2與4術(shù)后皮膚張力較高,出現(xiàn)張力性水泡,病例2術(shù)后三天皮瓣及邊緣出現(xiàn)紫暗,服用活血止痛湯后皮膚張力及水泡消退明顯,療效確切,病例4皮瓣完全存活、病例2皮瓣外側(cè)緣部分約2cm×2cm不死,經(jīng)換藥后痊愈。其余病例皮瓣及植皮區(qū)完全存活,皮瓣無明顯臃腫,外形良好,拇指外展功能恢復滿意。 結(jié)論前臂遠側(cè)有多源性供血的解剖學規(guī)律,橈動脈穿支在前臂中下1/3段分布密,前臂橈動脈穿支皮瓣內(nèi)部動脈穿支互相吻合成網(wǎng),形成鏈式供血,營養(yǎng)皮下組織及皮膚。臨床上可以設計前臂橈動脈穿支皮瓣來修復手部皮膚軟組織缺損及手部功能重建,其具有血供可靠,鄰近取材、轉(zhuǎn)移,皮膚質(zhì)地好,符合“相似組織替代”原則,成活率較高,1術(shù)程短,術(shù)中出血少,是臨床修復手部皮膚軟組織缺損及手部功能重建的良好供區(qū)。
[Abstract]:Objective to study the anatomical characteristics of perforating branch of radial artery of forearm, to provide anatomic basis for the design and clinical application of perforating branch flap of radial artery of forearm, to provide methods for repairing the wounds and functional reconstruction of hand, and to report the preliminary clinical application effect. Methods 118 adult upper limb specimens infused with red latex were studied. The radial styloid process was used as the observation marker. The 1/3 segments of the lower forearm were dissected microscopically. The distribution and anastomosis of the main vessels of the radial artery of the forearm were analyzed. The radial artery of the forearm and its perforating vessels were dissected (magnified by 5 times, and their origin, diameter, course, branch and distribution) were observed from June 2008 to January 2010. The radial artery perforator flap of forearm was used to repair the hand wound and hand function reconstruction, and 5 cases were treated with Huoxue Zhitong decoction after operation. Results there were about 14 perforating vessels from the radial artery of the forearm. The number of proximal segment was less (average 3) but the diameter was larger, the distal segment was more (average 11), but the diameter was smaller. Two or three perforating branches were sent out at 1/3, The external diameter of perforating branch from both sides of radial artery was 0.7 鹵0.4 mm, and the branches of perforating artery were anastomosed in the longitudinal direction. The main perforating branch of radial artery: 1 superficial dorsal branch of radial artery: after passing through the tendon of radial brachialis, the radial artery was descending on the lateral side. The starting point was 7.0 鹵1.1 cm above the styloid process of the radius, and the starting external diameter was 0.6 鹵0.3 mm. The radial artery was divided into two branches, the short ascending branch and the long descending branch, the palmar branch of the radial artery: the radial artery sent out the superficial palmar branch at the proximal carpal striae at the lower 1/3 segment of the forearm. The starting point was 1.5 鹵1.0 cm above the styloid process of the radius, 1.5 鹵0.2 mm in external diameter, 2.3 鹵1.0 mm in length and 2.3 鹵1.0 cm ~ (-1) in the recurrent branch of the styloid process of the radius. In the nasal fossa, 12 branches of the recurrent branch of the styloid process of the radius, 0.5 鹵0.3 cm, 1.0 鹵0.5 cm, 0.8 鹵0.1 mm of the recurrent branch of the styloid process, 12 branches of the recurrent radial artery or dorsal branch of the wrist, 0.5 鹵0.3 cm, 1.0 鹵0.5 cm, and 0.8 鹵0.1 mmm. of the recurrent branch of the styloid process, respectively. Nutrient vessels of perforating branch and cephalic vein, starting with external diameter of 0.5 鹵0.2mm. 4 branch of snuff fossa of radial artery: radial artery was located at the deep surface of abductor pollicis longus tendon and extensor pollicis brevis tendon from the distal end of the styloid process of the radius, and at the proximal segment of the snuff fossa of the radial artery. Or two perforating branches from the proximal end of the dorsal carpal branch, starting point 1.2 鹵0.3 cm from the inferior styloid process of the radius, and the external diameter of 0.6 鹵0.1 mm to 5 perforating branches of the artery: between 8.0 and 16.0 cm above the styloid process of the radius, the perforating branch of the musculocutaneous space of the radial artery was 13. The initial external diameter was 1.2 鹵0.2 mm 路m ~ (-1). Five patients were treated with Huoxue Zhitong decoction. Cases 2 and 4 had high skin tension, tension blisters, and purple dark skin flap and edge 3 days after operation in case 2. After taking Huoxue Zhitong decoction, the skin tension and blisters subsided obviously, and the curative effect was definite. The skin flap of case 4 completely survived, the lateral edge of case 2 was undead about 2 cm 脳 2 cm, and recovered after dressing change. The rest of the flap and skin grafting area survived completely. There was no obvious bloated skin flap, good appearance and satisfactory recovery of thumb abduction function. Conclusion there is an anatomical rule of multisource blood supply in the distal forearm. The perforating branch of radial artery is closely distributed in the 1/3 segment of the middle and lower forearm. The perforating branch of the radial artery flap anastomoses with each other to form a chain blood supply. Nutritional subcutaneous tissue and skin. Clinically, we can design the perforating branch flap of radial artery of forearm to repair the defect of skin and soft tissue of the hand and the reconstruction of hand function. It has reliable blood supply, adjacent materials, transfer and good texture of the skin. According to the principle of "similar tissue replacement", the survival rate is higher and the operative procedure is short, and the bleeding is less. It is a good donor area for clinical repair of hand skin and soft tissue defect and hand function reconstruction.
【學位授予單位】：福建中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R322

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