【摘要】：目的：1、研究前臂掌側(cè)淺靜脈網(wǎng)、手部掌淺弓、指總動(dòng)脈及指固有動(dòng)脈的解剖學(xué)特點(diǎn)。2、探討前臂掌測(cè)淺靜脈網(wǎng)在斷掌、多指離斷再植中的臨床意義。方法：1、尸體標(biāo)本研究：取20具成人尸體,共40個(gè)上肢標(biāo)本,經(jīng)乳膠灌注后用福爾馬林固定,分別對(duì)前臂掌側(cè)淺靜脈網(wǎng)的形態(tài)特點(diǎn)、管徑及瓣膜情況；對(duì)掌部的掌淺弓及指總動(dòng)脈及指固有動(dòng)脈的位置、大體形態(tài)、管徑情況進(jìn)行解剖學(xué)觀察和統(tǒng)計(jì)分析。2、臨床應(yīng)用：手掌嚴(yán)重?cái)D壓傷致手掌淺弓、掌深弓損傷,手指血供障礙,應(yīng)用前臂掌側(cè)淺靜脈網(wǎng)移植重建掌淺弓,恢復(fù)手指血供。 結(jié)果：解剖中發(fā)現(xiàn)在前臂掌側(cè)皮下的橈、前臂正中、貴要三條知名靜脈之間出現(xiàn)的屬支及交通支相互交織形成淺靜脈網(wǎng),該處淺靜脈的管徑(0.5mm～2.3mm)粗細(xì)不一,始終可找到與掌淺弓、指總動(dòng)脈及指固有動(dòng)脈的形態(tài)相匹配而管徑(0.8mm～2.7mm)相近似的靜脈網(wǎng),其中尤以前臂掌側(cè)淺靜脈網(wǎng)的2、3、4區(qū)最為相適,以前臂尺側(cè)淺靜脈支較多。臨床應(yīng)用該處淺靜脈網(wǎng)移植治療1例手掌擠壓傷致掌動(dòng)脈弓及其分支動(dòng)脈和拇指動(dòng)脈缺損患者,重建掌淺弓及指總動(dòng)脈,拇指尺側(cè)指固有動(dòng)脈,手指血運(yùn)恢復(fù)存活。術(shù)后隨訪11個(gè)月,按再植術(shù)后手功能評(píng)定標(biāo)準(zhǔn),功能恢復(fù)良好。結(jié)論：前臂掌側(cè)2、3、4區(qū)的淺靜脈網(wǎng)具有位置表淺,相對(duì)豐富,易于切取,供區(qū)損傷小的優(yōu)點(diǎn),更為重要的是,該處淺靜脈屬支數(shù)量較多,靜脈瓣少且形態(tài)不完整,屬支之間形成的網(wǎng)狀結(jié)構(gòu)和不同管徑可滿(mǎn)足各平面掌淺弓損傷的需要,先重建掌淺弓,其遠(yuǎn)端再與指總動(dòng)脈或指固有動(dòng)脈吻合,重建手指血液循環(huán),減少了血管橋接數(shù)量、難度,提高了手術(shù)成功率。為嚴(yán)重手掌部動(dòng)脈毀損傷實(shí)施血管移植提供了一個(gè)良好而恒定的“移植血管區(qū)”。
文內(nèi)圖片：
圖片說(shuō)明：各型斷掌的分區(qū)情況
[Abstract]:Objective: 1. To study the anatomical characteristics of the superficial palpal venous network of the forearm, the superficial palpal arch of the hand, the common digital artery and the fixed artery of the finger. 2. To explore the clinical significance of the superficial venous network of the forearm palms in replantation of severed palms and severed fingers. Methods: 1. Study on cadaveric specimens: 40 upper limb specimens from 20 adult cadavers were fixed with formalin after latex perfusion. The morphological characteristics, diameter and valve condition of superficial venous network on the palpal side of forearm were analyzed. Anatomical observation and statistical analysis were carried out on the position, gross shape and diameter of the superficial palpal arch and common digital artery and the fixed artery of the finger. 2. Clinical application: severe crush injury of the palm resulted in the superficial arch of the palm, the injury of the deep palpal arch, the disturbance of finger blood supply, and the reconstruction of the superficial palpal arch with superficial venous network transplantation of the forearm to restore the blood supply of the finger. Results: in the anatomy, it was found that in the middle of the forearm, the branches and communicating branches of the three well-known veins intertwined with each other to form a superficial venous network. The diameter of the superficial vein (0.5mm~2.3mm) was different, and a venous network similar to the shape of the superficial palpal arch, common artery and finger artery (0.8mm~2.7mm) could always be found. Among them, 2, 3 and 4 areas of the palmar superficial venous network of the forearm were the most suitable, and the ulnar superficial vein branches of the forearm were more. A case of palm artery arch and its branch artery and thumb artery defect caused by palm crush injury was treated with superficial venous network transplantation. the superficial palpal arch and common digital artery were reconstructed, the ulna digital artery of thumb was recovered, and the blood flow of finger was recovered. The patients were followed up for 11 months. According to the evaluation standard of hand function after replantation, the function recovered well. Conclusion: the superficial venous network in area 4 has the advantages of superficial position, relatively abundant, easy to cut and less injury in donor area. More importantly, the number of superficial vein branches is large, the venous flap is few and incomplete, the reticular structure and different diameter between branches can meet the needs of superficial palpal arch injury in each plane, and its distal end is anastomosed with common digital artery or proper digital artery. The reconstruction of finger blood circulation reduces the number and difficulty of vascular bridge, and improves the success rate of operation. It provides a good and constant "vascular transplantation area" for severe palm artery destruction and injury.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類(lèi)號(hào)】：R658.2;R322

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