国人锁骨下动脉的分枝类型

TYPES OF BRANCHING OF THE SUBCLAVIAN ARTERY IN THE CHINESE

1.锁骨下动脉,左侧起于主动脉弓的非常固定,右侧起于头臂干的时有变异,较常见的是成为主动脉弓的第四枝向右过脊柱与食管之间而后经路与一般的相同,这种变异本材料中有3.3±1.6%。血管周径右侧粗的居多。2.锁骨下动脉分枝,个体差异很大,分枝数变动于3—6枝之间,本材料中以四个独立枝的居多为总数的39.3±3.1%,四枝中含有椎动脉、甲状颈干、胸廓内动脉、肋颈干等四个独立枝,而甲状颈干由甲状腺下、颈升、颈浅、肩胛上、颈横等五枝组成的为代表型,为总数的32.7±3.0%。3.锁骨下动脉分枝类型在个体上的分布,变动性很大,有31.1±4.1%是对称型,有68.9±4.1%是不对称型,对称型中以第Ⅱ型之第1分型为多,居总数的16.4±3.3%,不对称中以左侧Ⅱ型右侧Ⅲ型的较多见,为总数的10.6±2.7%,其次是左侧Ⅲ型右侧Ⅱ型的为总数的9.0±2.5%。4.椎动脉两侧起于锁骨下动脉的居多,占总数的92.2±1.7%,左侧椎动脉直接起于主动脉弓的也较常见,本材料中有5.7±1.4%。血管周径两侧等粗的较多,为42.7±3.4%,右侧粗的较少为17.6±3.6%,本动脉向上进入第六颈椎横突孔的为最多,占总数的82.4±2.5%,尚有10.2±2.1%进入第五颈椎横突孔。5.胸廓内动脉,独立由锁骨下动脉起始的占82.4±2.4%共同干中以与甲状颈干同干的为多,占11.0±2.0%,与肩胛上同干的5.7±1.5%,起点居前斜角肌内侧的为98.8±0.6%,位于后方及外侧的较少。6.甲状腺下动脉由甲状颈干起始的非常固定,为94.3±1.4%,有少数起于锁骨下动脉或椎动脉,本动脉有时完全缺如,或特别细弱而不能达及腺体,此时主要由甲状腺最下动脉或本侧甲状腺上动脉代替之。7.颈升动脉的起始,变动性大,有41.0±3.1%起于甲状颈干,有29.1±2.9%起于颈横动脉,15.1±2.2%起于甲状颈干,有8.6±1.7%起颈浅动脉,4.5±1.3%起于肩胛上动脉,少数有双枝存在。8.肩胛上动脉的起始,变动性较大,有37.7±3.1%起于甲状颈干,有30.8±2.9%起于锁骨下动脉。20.5±2.5%与颈横动脉同干起于甲状颈干,还有的起于胸廓内或与颈横动脉同干起自锁骨下动脉的。起点位于前斜角肌内侧的居多,有60.6±3.1%,居后方的较少见,由前斜角肌内侧起始的都过臂丛神经的浅面,反之则穿过或过臂神经丛的下方。9.颈横动脉的起始,各国人间的差异很大,本材料中以起自甲状颈干的为多,占45.5±3.1%,起自锁骨下动脉的有29.1±2.9%,与肩胛上动脉同干起于甲状颈干的20.5±2.5%,还有的与肩胛上同干起自锁骨下动脉或起胸廓内动脉的。起点居前斜角肌内侧的篇多。10.颈浅动脉由颈横动脉起始的67.2±3.0%,由甲状颈干起始的27.0±2.8%,还有的起于肩胛上动脉或锁骨下动脉。11.肋颈干是锁骨下动脉分枝中非常固定的一枝,本材料中有90.9±1.8%,有少数颈深动脉与最上肋间动脉不成干而独立起始的,肋颈干两侧起点左侧位第一段的有81.1±3.5%,右侧位第二段的有93.5±2.2%,颈深动脉多过第一肋骨上面而最上肋间动脉多过第一肋骨前面分布,仅有少数过肋骨下面或后面的,其分布区域以第一、二肋间隙的为最多见。综合观察材料中,除椎动脉起于锁骨下动脉右侧较多见,(其侧差12.3±3.5%),及胸廓内动脉起始于锁骨下动脉者右侧多于左侧者(侧差18.8±4.7%)外,其它部分男女性差及左右侧差均不显著。

The subclavian artery of 122 Chinese children(male 54,female 68 with abody length of 50—120cm)was studied.It was found that branches arisingdirectly from the subclavian artery were 3 to 6 in number,among which the4-branch type was comparatively more than the other types(39.3%).These branches consisted of the vertebral,the thyro-cervical trunk,thecosto-cervical trunk and the internal mammary artery.The thyro-cervical trunkwas composed of the inferior thyroid,the ascending cervical,the suprascapularand the transverse scapular artery.The transverse cervical artery arose morefrequently from the thyro-cervical trunk(total 66.0%;45.5%independently,20.5%together with the suprascapular artery)than as a direct branch of thesubclavian artery(total 33.6%;29.1%independently,4.5%together with thesuprascapular artery).This observation on the transverse cervical artery coinsides with the des-cription of the English authors but does not agree with that of current text-books in which it is stated that the transverse cervical artery arises directlyfrom the subclavian artery.In about 1/3 of the cases(31.1%)branching was symmetrical whereas inabout 2/3 of the cases(68.9%)it was asymmetrical.