【摘要】： 目的：本實驗觀察了橈神經(jīng)淺支在鼻煙窩區(qū)的走行及其與頭靜脈的毗鄰關(guān)系；橈動脈鼻煙窩段的形態(tài)及其分支的起始點到橈骨莖突的情況,并以此為基礎(chǔ),探討應(yīng)用改良鼻煙窩皮瓣治療腕手部橈側(cè)皮膚軟組織缺損的手術(shù)方法。 方法：采用經(jīng)福爾馬林常規(guī)固定的成尸上肢手標(biāo)本40側(cè)(男18例、女2例),部分經(jīng)紅色乳膠灌注,常規(guī)解剖并觀察頭靜脈、橈神經(jīng)淺支的毗鄰情況；橈神經(jīng)淺支分支走行及變異情況；橈動脈鼻煙窩段的形態(tài)及其分支的起始點到橈骨莖突的情況。用游標(biāo)卡尺測量橈神經(jīng)淺支分內(nèi)外側(cè)支處到橈骨莖突的距離；橈動脈鼻咽窩段長度、近側(cè)端和遠(yuǎn)側(cè)端的外徑,測量該動脈恒定分支腕背支和拇指背動脈發(fā)出點位置距橈骨莖突距離；橈動脈莖突返支起始點距橈骨莖突距離。并以此為基礎(chǔ),以橈骨莖突為旋轉(zhuǎn)點設(shè)計改良鼻煙窩皮瓣,臨床應(yīng)用治療腕手部橈側(cè)皮膚軟組織缺損18例。 結(jié)果：橈神經(jīng)淺支于橈骨莖突上5.14±0.12cm處分為內(nèi)外側(cè)支,未發(fā)現(xiàn)三支、變異者,橈動脈鼻煙窩段長度為2.50±0.18cm,其近側(cè)端和遠(yuǎn)側(cè)端的外徑分別為2.60±0.10mm和2.20±0.13mm。該段橈動脈恒定分支為腕背支和拇指背動脈,腕背支起自主干的尺側(cè),在橈骨莖突下方1.20±0.11cm處發(fā)出；拇指背動脈起于該動脈的外側(cè)壁,在橈骨莖突下方1.50±0.12cm處發(fā)出。此二分支發(fā)出高度均較恒定。橈動脈莖突返支起始點距橈骨莖突距離為1.20±0.20cm,該支恒定發(fā)出。以上述解剖結(jié)構(gòu)為基礎(chǔ),以橈骨莖突為旋轉(zhuǎn)點設(shè)計改良鼻煙窩皮瓣,臨床應(yīng)用治療腕手部橈側(cè)皮膚軟組織缺損18例,皮瓣全部成活,1例出現(xiàn)遠(yuǎn)端部分表皮壞死,經(jīng)換藥后愈合,皮瓣質(zhì)地柔軟,血運良好。 結(jié)論：應(yīng)用改良鼻煙窩皮瓣治療腕手部橈側(cè)皮膚軟組織缺損具有操作簡便、安全、質(zhì)地薄,無需再次整形等優(yōu)點,較傳統(tǒng)的鼻煙窩皮瓣擴大了修復(fù)的面積,是一種較好的修復(fù)方法。
[Abstract]:Objective: to observe the route of the superficial branch of radial nerve in the nasopharyngeal fossa and its relationship with the cephalic vein, the morphology of the nasopharyngeal fossa of the radial artery and the origin of the branch to the styloid process of the radius. To explore the surgical method of modified nasopharyngeal fossa flap in the treatment of radial skin and soft tissue defect of wrist and hand. Methods: 40 hand specimens (18 males and 2 females) of cadaveric upper limbs fixed by formalin were perfused with red latex, and were dissected by routine anatomy and observed the adjacent situation of the superficial branch of radial nerve and cephalic vein. The course and variation of the branches of the superficial branch of the radial nerve, the morphology of the snuff fossa of the radial artery and the origin of the branch to the styloid process of the radius. Vernier caliper was used to measure the distance from the mediolateral branch of the superficial branch of the radial nerve to the styloid process of the radius, the length of the nasopharyngeal fossa of the radial artery, and the external diameter of the proximal and distal ends of the radial nerve. The distance from the point of origin of the dorsal carpal branch and the dorsal thumb artery to the styloid process of the radius and the distance from the origin of the recurrent branch of the styloid process of the radial artery to the styloid process of the radius were measured. On this basis, the modified nasal fossa flap was designed with the radial styloid process as the rotation point. 18 cases of wrist and hand radial skin and soft tissue defect were treated clinically. Results: the superficial branch of radial nerve was dissected to the lateral and lateral branches of the styloid process of the radius by 5.14 鹵0.12cm. The length of the nasal fossa of the radial artery was 2.50 鹵0.18 cm, and the external diameters of the proximal and distal ends were 2.60 鹵0.10mm and 2.20 鹵0.13 mm, respectively. The radial artery is a constant branch of the dorsal carpal branch and the dorsal thumb artery. The dorsal carpal branch is located at the ulnar side of the autonomic trunk, and the dorsal thumb artery originates from the lateral wall of the radial styloid process at 1.50 鹵0.12cm below the styloid process of the radius, and the dorsal thumb artery originates from the lateral wall of the radial styloid process. The emission height of these two branches is constant. The distance from the starting point of the recurrent branch of the styloid process of the radial artery to the styloid process of the radius was 1.20 鹵0.20 cm. Based on the above anatomical structure, the modified nasopharyngeal fossa flap was designed with the styloid process of the radius as the rotation point. 18 cases of radial skin and soft tissue defects of wrist and hand were treated clinically. All the flaps survived in 1 case with partial epidermal necrosis at the distal end and healed after dressing change. The skin flap is soft in texture and good in blood circulation. Conclusion: the modified nasopharyngeal fossa flap has the advantages of simple operation, safety, thin texture and no need to reform the skin and soft tissue defect of the wrist and hand, and it has expanded the area of repair compared with the traditional nasal smoke fossa flap. It is a better repair method.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R322

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