手内在肌的血供与肌瓣设计的解剖学基础

Vascular anatomy of intrinsic muscle flaps of the hand

目的:研究手内在肌的血供为肌瓣的设计提供解剖学基础。方法:(1)红色乳胶灌注的上肢标本20侧,解剖并观测手内各动脉的起始部位,测量其管径及其走行,分支、分布情况等。(2)动脉灌注明胶-氧化铅混悬液的新鲜成人整尸标本10具,解剖取下各手内在肌,拍摄X线片。利用Photoshop与ScionImage对X线影像进行分析处理,观测营养动脉在肌内的分布、分型及彼此间的吻合情况等。结果:18块手内在肌共有(58.0±5.9)支动脉供血,平均(3.0±1.0)支,平均外径及其供血区域的长度与宽度分别为:(0.8±0.2)mm,(2.2±0.4)cm,(1.0±0.2)cm。结论:(1)手内在肌的血运丰富,其起、止点处的血管网亦丰富,具备切取肌瓣或肌骨(膜)瓣的解剖学基础。(2)其中有9块肌肉的主供血动脉之管径较粗大且恒定,易于解剖与取瓣,可供临床选用。

Objective： To define the vascular supply of the individual intrinsic muscle of the hand, and identify the dominant arterial pedicle of each muscle for potential use of these muscles as muscle flaps. Methods： Ten adult fresh cadavers specimens were perfused with lead oxide-gelatine mixture. The intrinsic muscles were meticulously dissected along with their vascular pedicles, removed and radiographed. The number, type, diameter of vascular pedicles of muscles and their distribution were analyzed. Twenty adult upper limb cadaveric specimens were perfused with red latex and above dissection protocol was followed. Radiographs of tissue specimens were digitally analyzed using the software Photoshop and Scion Image for Windows. Results： On analyzing the results, there were 58.0±5.9 arteries supplied 18 hand muscles, and each muscle received an average of 3.0±1.0 vascular pedicles. The average diameter, vascular territorial area and the length and width of each pedicle was 0.8±0.2 mm, 2.2±0.4 cm, and 1.0±0.2 cm, respectively. Conclusions： （1） The abundant connections have been documented between the arterial territories of the intrinsic muscles and the vascular connection between muscle fibers and bones at either the origin or insertion allow elevation of bone with the flap. （2） Nine intrinsic hand muscles have been identified which can potentially be used as a muscle flap or musculocutaneous or musculo-osseous flap. The vascular pedicles of hand muscles show the variation in size and courses. However this anatomic study provides further information for helping to design various flaps from the hand and the local transferation.