下肢动脉粥样硬化闭塞症截肢残体的血管解剖及临床意义

Anatomy of Blood Vessels in Amputated Lower Extremity Residual Body after Atherosclerosis Obliteration and Its Clinical Significance

目的为晚期的下肢动脉粥样硬化闭塞症(ASO)治疗寻找远端流出道提供解剖学基础。方法收集10条因晚期下肢ASO而行膝上截肢的残体,进行血管灌注。观察腘动脉、胫前动脉、胫后动脉及其侧支的病理改变,以及各侧支的数量、分布规律等情况。结果本组腘动脉、胫前动脉及胫后动脉均呈动脉粥样硬化闭塞。这些动脉发出的侧支有3种类型:①部分侧支因主干动脉粥样斑块波及填塞而闭塞。②部分侧支仅起始段闭塞,远端仍通畅。③部分侧支通过主干动脉内"滴水状间隙"相互交通。后2种类型主要分布于腘动脉的下段及胫前动脉、胫后动脉的上段,并可在小腿肌群内形成广泛、固定的血管吻合。结论晚期的下肢ASO,腘动脉、胫前动脉及胫后动脉虽闭塞,但在某些固定部位仍存在未闭塞的多个侧支,一旦此段主干动脉行内膜剥脱后即可构建远端"侧支流出道"。

Objective To provide the anatomical basis for detecting distal outflow tract in late atherosclerosis obliteration in lower extremities. Methods Ten lower extremities that were amputated above knees because of late atherosclerosis obliteration were used in this experiment. The blood vessels in the residual bodies were perfused to run blood vessel cast mould to observe the anatomical and pathological change of the popliteal artery, the anterior and posterior tibial arteries and their collateral vessels. The number and distribution of those collateral vessels were also observed. Results The popliteal artery, anterior and posterior tibial arteries were all occluded due to atherosclerosis. However, there were three types of those collateral arteries： ① Atheromatous plaque in bole stretched into collateral arteries and led to occlusion. ② Obliteration was only observed at the initial segment, with no obstruction at the distal end but extenuated. ③ The collateral arteries originated from the bole artery symmetrically, keeping communicative with each other through punctiform interspaces. The last two types were mainly distributed at the inferior segment of popliteal artery, the superior segment of anterior and posterior tibial arteries, forming vascular anastomosing network in the whole cnemis muscle group. Conclusion Un-obstructed collateral arteries in certain places can be still found, though atherosclerosis obliteration is formed in popliteal artery, anterior and posterior tibial arteries in lower extremities. Therefore, it may be possible to construct collateral outflow tracts if endo-membrane stripping operation is performed.