本文選題：背闊肌 + 復合組織瓣��； 參考：《廣西醫(yī)科大學》2010年碩士論文

【摘要】： 目的：探索增強背闊肌遠端肌力的方法及背闊肌鄰近可以協(xié)同其重建上肢運動功能的肌肉,為背闊肌復合組織瓣重建上肢運動功能提供解剖學依據(jù)。 方法：通過解剖16側(cè)10%福爾馬林液固定成人尸體標本,觀察背闊肌遠端與鄰近肌肉的關(guān)系及穿入背闊肌遠端的肋間后血管、脊神經(jīng)后支,觀察同側(cè)背闊肌與前鋸肌的形態(tài)、血管、神經(jīng)以及位置關(guān)系。使用spss13.0統(tǒng)計軟件進行數(shù)據(jù)統(tǒng)計。 結(jié)果：背闊肌遠端腱膜表面有厚19.3±5.69mm的淺筋膜覆蓋,與下后鋸肌起點及豎脊肌表面的胸腰筋膜愈合緊密,愈合處胸腰筋膜長13.5±3.71cm、寬6.79±2.44 cm,腱膜增厚至1.45±0.19mm；下后鋸肌、豎脊肌緊貼于背闊肌遠端深面,血供來自肋間后動脈及腰動脈,接受相應體節(jié)的脊神經(jīng)后支節(jié)段性支配。背闊肌遠端有血管、神經(jīng)伴行自肌肉深面穿入,血管為肋間后動脈分支、腰動脈分支,僅1～2支外徑較粗大；脊神經(jīng)后支伴隨肋間后動脈的分支或腰動脈的分支穿過背闊肌遠端。前鋸肌下部肌齒于第6～9肋水平緊貼在胸壁外側(cè)的背闊肌深面；背闊肌與前鋸肌下部共血管干,主要接受收胸背動脈的血供,血管外徑2.18±0.46mm、血管蒂部長達9cm以上；背闊肌、前鋸肌有獨立的神經(jīng)支配。前鋸肌下部肌齒之間存在夾角,肌齒內(nèi)肌纖維以止點為中心呈放射狀向胸前外側(cè)分布；胸長神經(jīng)對前鋸肌的神經(jīng)支配呈明顯節(jié)段性,下行過程發(fā)出8～10支細、短分支支配前鋸肌各個肌齒。 結(jié)論：1.帶背闊肌遠端胸腰筋膜及增厚淺筋膜的背闊肌復合組織瓣可以加強背闊肌遠端的組織結(jié)構(gòu)。 2.下后鋸肌、豎脊肌不適合與背闊肌形成背闊肌復合組織瓣應用于上肢運動功能重建。 3.帶前鋸肌下部的背闊肌復合組織瓣可以應用于上肢運動功能重建。
[Abstract]:Objective: to explore the method of enhancing the distal muscle strength of latissimus dorsi and to provide anatomic basis for the reconstruction of motor function of upper limb by the muscle adjacent to latissimus dorsi muscle. Methods: 16 adult cadavers fixed with 10% formalin solution were dissected to observe the relationship between the distal part of latissimus dorsi and adjacent muscles, the posterior intercostal vessels and posterior branches of spinal nerve, and the morphology of ipsilateral latissimus dorsi and serratus anterior muscle. Blood vessels, nerves, and location. Use spss13.0 statistical software for data statistics. Results: the surface of the distal fascia of latissimus dorsi was covered with 19. 3 鹵5.69mm superficial fascia, which was close to the thoracolumbar fascia at the beginning of the posterior serratus and the surface of the vertical spinal muscle. The length and width of the fascia were 13.5 鹵3. 71 cm, 6. 79 鹵2. 44 cm, and the aponeurosis thickened to 1. 45 鹵0. 19 mm, respectively, and the posterior serratus muscle was thickened to 1. 45 鹵0. 19 mm. The vertical spinal muscle is close to the distal side of the latissimus dorsi. The blood supply comes from the posterior intercostal artery and the lumbar artery and receives the segmental innervation of the dorsal branch of the spinal nerve of the corresponding body ganglia. There were vessels in the distal part of the latissimus dorsi muscle, and the nerve was perforated from the deep side of the muscle. The branches of the posterior intercostal artery and the lumbar artery were the branches of the posterior intercostal artery, and the branches of the lumbar artery and the posterior branch of the spinal nerve accompanied by the branch of the posterior intercostal artery or the branch of the lumbar artery passed through the distal part of the latissimus dorsi muscle. The lower muscle teeth of the serratus anterior muscle are close to the deep side of the latissimus dorsi outside the chest wall at the 69th rib level, and the latissimus dorsi muscle shares the trunk of the blood vessel with the lower part of the serratus anterior muscle, and mainly receives the blood supply of the adductive dorsal artery with an external diameter of 2.18 鹵0.46 mm, and the vascular pedicle is more than 9cm, the latissimus dorsi muscle, The anterior serratus has an independent innervation. There is an angle between the lower muscle teeth of the anterior serratus, the fibers of the intraodontic muscle radiate to the anterolateral chest, and the long thoracic nerve innervates the anterior serratus in a segmental manner, with 810 fine fibers in the descending process. The short branches innervate the teeth of the serratus anterior muscle. Conclusion 1. The distal structure of latissimus dorsi muscle can be enhanced by the composite flap of latissimus dorsi with distal thoracolumbar fascia and thickened superficial fascia. 2. The posterior serratus and the vertical spinal muscle are not suitable for the reconstruction of motor function of the upper extremity with the latissimus dorsi complex tissue flap. 3. Latissimus dorsi composite tissue flap with lower part of serratus anterior muscle can be used to reconstruct motor function of upper limb.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R322

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