本文選題：胸背動脈 + 穿支瓣��； 參考：《安徽醫(yī)科大學(xué)》2008年碩士論文

【摘要】： 目的探討保留胸背神經(jīng)的胸背動脈穿支皮瓣的解剖學(xué)基礎(chǔ)及臨床應(yīng)用的效果。 方法①選用16具32側(cè)成人軀干標(biāo)本,對胸背神經(jīng)、血管進(jìn)行顯微解剖觀測;②在1具防腐成人尸體標(biāo)本上,行胸背動脈穿支皮瓣手術(shù)的模擬;③在解剖研究基礎(chǔ)上,應(yīng)用保留部分胸背神經(jīng)的背闊肌皮瓣或肌皮穿支瓣移植修復(fù)肢體和頭面部大塊皮膚軟組織缺損共9例。其中應(yīng)用胸背動脈內(nèi)側(cè)支為蒂3例,外側(cè)支為6例。均攜帶相應(yīng)的胸背神經(jīng)分支。 結(jié)果①背闊肌肌肉及其表面的皮下組織、皮膚是多源性供血,以胸背動脈及其肌皮穿支為主要供血血管,同時還有肋間動脈、腰動脈供血;②從胸背神經(jīng)一級分支分叉處向近心端至見到內(nèi)側(cè)支和外側(cè)支之間有神經(jīng)纖維交織處長度為(25.12±3.19)mm。胸背動脈起始部外徑為(2.32±0.15)mm,總干長為(56.75±4.99)mm。胸背神經(jīng)起始部干徑為(2.14±0.29)mm,總干長為(61.22±8.51)mm。胸背神經(jīng)與胸背動脈之間及一級分支之間的最寬距離是(2.98±0.08)mm。肌皮穿支在肌內(nèi)斜行距離為(42.78±13.24)mm,肌皮穿支入肌時背闊肌厚度為(4.15±1.24)mm,水平投影距離為(42.55±13.28)mm;③在32側(cè)標(biāo)本中,隨機(jī)選擇了第一、第二肌皮穿支觀察,共64支,血管外徑均大于0.5mm;④4例轉(zhuǎn)移皮瓣、5例吻合移植,術(shù)后皮瓣完全成活。保留背闊肌的外形良好,肩關(guān)節(jié)內(nèi)收、內(nèi)旋、后伸功能與術(shù)前無明顯差異。 結(jié)論①胸背動脈和胸背神經(jīng)的一級分支可分離切取移植,另一分支功能不受影響;②以胸背動脈肌皮穿支為蒂的肌皮穿支瓣移植,供區(qū)病損小;③應(yīng)用保留胸背神經(jīng)的部分背闊肌皮瓣移植或帶少量肌袖的胸背動脈穿支皮瓣移植,可根據(jù)缺損情況隨機(jī)切取肌肉量,最大限度地保留了背闊肌的功能,是軀體大塊組織缺損較理想的修復(fù)方法。
[Abstract]:Objective to investigate the anatomical basis and clinical application of dorsal thoracic artery perforator flap preserving thoracic dorsal nerve. Methods 1 A total of 16 adult trunk specimens (32 sides) were selected to observe the microanatomy of thoracic dorsal nerve and blood vessel on 1 embalmed adult cadavers, and the anatomic study was carried out on the basis of anatomic study on the operation of perforating branch flap of thoracic dorsal artery. The latissimus dorsi flap or musculocutaneous perforating branch flap was used to repair large skin and soft tissue defects of limbs and head and face in 9 cases. The medial branch of the dorsal thoracic artery was used as pedicle in 3 cases and the lateral branch in 6 cases. All of them carried the corresponding branches of thoracic dorsal nerve. Results 1latissimus dorsi muscle and its surface subcutaneous tissue, the skin is multi-source blood supply, the thoracic dorsal artery and its musculocutaneous perforating branch as the main blood supply vessel, but also the intercostal artery, the lumbar artery; (2) the length of nerve fibers intertwined between the medial and lateral branches from the first branch of the thoracic dorsal nerve to the proximal end of the heart was 25.12 鹵3.19mmm. The external diameter of the starting part of the thoracic dorsal artery was 2.32 鹵0.15 mm and the total trunk length was 56.75 鹵4.99 mm. The diameter of the initial trunk of the thoracic dorsal nerve was 2.14 鹵0.29 mm and the total length of the trunk was 61.22 鹵8.51 mm. The widest distance between the dorsal thoracic nerve and the thoracic dorsal artery and the first branch was 2.98 鹵0.08mm. The distance of the perforating branches in the muscle was 42.78 鹵13.24mm, the thickness of latissimus dorsi was 4.15 鹵1.24mm, and the distance of horizontal projection was 42.55 鹵13.28mm. The first and second musculocutaneous perforators were randomly selected for observation. The external diameters of the vessels were greater than 0.5 mm in 44 cases and 5 cases were anastomosed and the flap survived completely after operation. The shape of latissimus dorsi was good. There was no significant difference in shoulder adductor, internal rotation and extension function between before and after the preservation of latissimus dorsi. Conclusion (1) the primary branches of the dorsal thoracic artery and the thoracic dorsal nerve can be removed and transplanted separately, and the other branch function is not affected. 2 the graft pedicled with the musculocutaneous perforating branch of the thoracic dorsal artery has little lesion in the donor area. 3Transplantation of partial latissimus dorsi musculocutaneous flap with preservation of thoracic dorsal nerve or transplants of perforating branch of thoracic dorsal artery with a few muscle cuff, muscle quantity can be randomly cut according to the condition of defect, and the function of latissimus dorsi muscle can be preserved to the maximum extent. It is an ideal method for repairing body mass tissue defect.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2008
【分類號】：R322;R622

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