本文選題：下頜骨 + 胸廓內血管��； 參考：《山東大學》2009年碩士論文

【摘要】： 目的: 研究胸廓內血管及其前穿支對前胸壁組織供血的解剖學要點;探索以胸廓內血管為蒂的肋骨復合組織瓣修復口腔下頜骨組織缺損的臨床應用。 方法: 1、解剖學研究: 1.1新鮮成人尸體胸部2具4側,自胸廓內動靜脈起始處分別灌注紅、藍乳膠墨水。觀察1)胸廓內血管的起源;2)胸廓內血管諸穿支供應胸部皮膚的范圍;3)胸廓內動脈諸穿支穿出胸壁的位置、走行、長度、外徑、分支數(shù)目、吻合情況。 1.2 10%福爾馬林固定未超過6個月的成人尸體胸部15具30側,采用巨微解剖學方法,觀察1)胸廓內血管及皮膚穿支在肌肉、皮下的走行;2)用鋼尺和卡尺測量并攝影記錄。測量:諸前穿支穿出胸壁的具體位置、長度、外徑、分支數(shù)目、吻合情況;3)確定體表投影,設計以胸廓內血管前穿支為血管蒂的皮瓣切取范圍。 2、臨床初步應用:13例下頜骨缺損病例,男性7例,女性6例;年齡:22歲—55歲;缺損部位:下頜骨缺損位置以體部和升支部為多(5例),單側角部4例,累及雙側及頦部4例,缺損最大為11 cm,伴軟組織缺損5例。修復方式:以胸廓內動靜脈為供區(qū)血管的肋骨復合組織瓣游離移植術8例,以胸廓內動靜脈為供區(qū)血管的肋骨游離移植術5例,骨源均選擇第5肋骨肋軟骨。受區(qū)血管:8例選擇面動靜脈,4例選擇甲狀腺上動脈,1例選擇顳淺動靜脈。 結果: 1.左側17例標本有15例胸廓內動脈直接起源于鎖骨下動脈,占88.2%,2例與其它動脈共干發(fā)出。右側17例16例起源于鎖骨下動脈,占94.1%,1例與其它動脈共干發(fā)出。 2.胸廓內動脈穿支動脈多起自胸廓內動脈的內側壁,前穿支的出現(xiàn)率以1-4穿支最常見,出現(xiàn)率為100%,且口徑較為粗大,各穿支之間有豐富的血管吻合現(xiàn)象,穿支動脈的伴行靜脈多為一支。 3.穿支動脈自胸廓內動脈發(fā)出后,穿過胸內筋膜、肋間內肌、肋間筋膜和胸大肌等方可淺出。淺出處與起點間存在著一定的偏離。 4.各支穿動脈的分布區(qū)各有一個相對集中區(qū),第2穿動脈的中心分布區(qū)在第2和3肋間隙,第3穿動脈的中心分布區(qū),在第3和4肋間隙,第4穿動脈的中心分布區(qū),在第4和5肋間隙,以此可確定各穿支血管所對應的供區(qū)范圍。 5.13例血管化游離肋骨瓣＼骨肌皮瓣均全部成活,未見感染或壞死,未發(fā)生血管危象。 結論: 1、胸廓內動脈肋間穿支動脈的出現(xiàn)率以2、3、4穿支最為恒定,且口徑較為粗大,適合做血管吻合。血管吻合應選擇胸廓內血管穿支起始端。制作皮瓣時可保留真皮下血管網(wǎng),修除部分脂肪組織。 2、所切取胸前區(qū)皮瓣上下范圍為該穿支所在肋間及其下一位肋間。 3、對于口腔下頜骨復合組織缺損的病例,以胸廓內血管為蒂的肋骨復合組織瓣是一種較理想的修復方法。
[Abstract]:Objective: To study the anatomical points of intrathoracic vessels and their anterior perforating branches on the blood supply of anterior thoracic wall, and to explore the clinical application of rib composite tissue flap pedicled with intrathoracic vessels to repair oral and mandibular bone defects. Methods: 1. Anatomical studies: 1.1 Red and blue latex ink were infused into the chest of 2 fresh adult cadavers from the beginning of internal thoracic arteriovenous vein. 1) the origin of intrathoracic vessels (2) the range of perforators supplied to the thoracic skin (3) the location, length, diameter, number of branches and anastomosis of the perforating branches of the internal thoracic arteries out of the chest wall. 1.2 Fifteen cadavers with 30 sides of adult cadavers less than 6 months old were fixed with 10% formalin. Giant microanatomy was used to observe 1) intrathoracic blood vessels and skin perforating branches in muscles, subcutaneous walking and 2) measuring and recording with steel and caliper. Measurement: the specific position, length, external diameter, number of branches and anastomosis of the anterior perforating branches were used to determine the projection of the body surface, and the range of the flap pedicled with the anterior perforating branch of the thoracic blood vessel was designed. 2, 13 cases of mandibular defect were treated clinically, male 7 cases, female 6 cases; age: 22 to 55 years old; defect site: 5 cases of mandibular defect located in body and ascending branch, 4 cases of unilateral angle, 4 cases of bilateral and mental involvement. The maximum defect was 11 cm, with soft tissue defect in 5 cases. The repair methods were as follows: there were 8 cases of free rib graft with internal thoracic artery and vein as donor vessel and 5 cases of rib free graft with intrathoracic artery and vein as donor vessel. The fifth rib cartilage was selected as bone source. In 8 patients with selective facial arteriovenous stenosis, 4 patients with superior thyroid artery and 1 patient with superficial temporal arteriovenous artery were selected. Results: 1. In the left 17 cases, 15 cases of the internal thoracic artery originated directly from the subclavian artery, accounting for 88.2% of the artery and other arteries in 2 cases. The right 17 cases (16 cases) originated from the subclavian artery (94.1%) and 1 case came out of the trunk with other arteries. 2. The internal thoracic artery perforating artery often occurs from the medial wall of the internal thoracic artery. The most common occurrence rate of the anterior perforating branch is 1-4 perforating branch, the occurrence rate is 100%, and the diameter is relatively large, and there is abundant vascular anastomosis between each perforating branch. Most of the accompanying veins perforating the artery are one. 3. When the perforating artery originates from the internal thoracic artery, it can be shallowly through the intrathoracic fascia, intercostal muscle, intercostal fascia and pectoralis major. There is a certain deviation between the shallow source and the starting point. 4. Each branch of perforating artery had a relatively concentrated area. The central area of the second perforating artery was in the second and third costal space, the central distribution of the third perforating artery was in the third and fourth costal space, and the central distribution of the 4th perforating artery. In the fourth and fifth intercostal spaces, the donor region corresponding to perforating vessels can be determined. 5.13 cases of vascularized free rib flap\ bone myocutaneous flap all survived, no infection or necrosis, no vascular crisis. Conclusion: 1. The incidence of intercostal perforating branching artery of internal thoracic artery was the most constant in 2 ~ 3 ~ 4 perforating branch, and the diameter of the perforating branch was thicker, so it was suitable for vascular anastomosis. Vascular anastomosis should select the first end of the perforating branch of the intrathoracic blood vessel. When making the flap, the subdermal vascular network can be preserved and some adipose tissue can be repaired. 2, the upper and lower region of the anterior thoracic area flap is the intercostal and the next intercostal region of the perforating branch. 3. For the patients with oral and mandibular composite tissue defect, rib composite flap pedicled with intrathoracic vessels is an ideal repair method.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2009
【分類號】：R322

【參考文獻】

相關期刊論文 前10條

1 梁大寧,羅少軍,湯少明,呂端遠,張新營;第2～6肋間神經前皮支及其營養(yǎng)血管的解剖學研究[J];廣東醫(yī)學院學報;2003年01期

2 劉懷琛,王永賢,易信剛,李賦僗;胸前皮瓣血管的觀測及其調查[J];四川醫(yī)學院學報;1982年02期

3 王文林,鐘世鎮(zhèn),王武軍,李忠華;胸壁復合組織瓣用于心臟外科小切口的解剖學研究[J];中國局解手術學雜志;2000年03期

4 丁學強,羅智斌,連克乾,陳宇,陳丹;帶血管髂骨瓣移植同期種植體植入整復節(jié)段性下頜骨缺損[J];中國口腔種植學雜志;2003年01期

5 孫要文,陳秦吉,張振信,楊旅軍,周治理,劉曉軍;胸廓內動脈前穿支島狀瓣修復面頸部創(chuàng)面[J];中國美容醫(yī)學;1999年03期

6 李祖兵,余世斌,東耀峻,趙吉宏;下頜骨缺損重建植入材料的回顧性研究[J];實用口腔醫(yī)學雜志;2003年01期

7 姬尚義,陳長春;二維多普勒定量評價架橋前后乳內動脈血流特性變化[J];實用醫(yī)學雜志;2000年10期

8 張發(fā)惠,陳振光,劉經南,王珊;胸廓內血管蒂肋軟骨瓣移植修復關節(jié)軟骨缺損的研究[J];中華實驗外科雜志;2000年06期

9 竺涵光,張志愿,顧章愉,馬玉中,鄭家偉,王旭偉,林國礎,邱蔚六;腓骨游離瓣重建口腔下頜骨缺損[J];中華顯微外科雜志;1999年S1期

10 鐘世鎮(zhèn),陳子華,李漢云,劉牧之,徐達傳,孫博;吻合血管移植肋軟骨的應用解剖學[J];臨床應用解剖學雜志;1983年02期

，

本文編號：1889713