指掌侧固有动脉蒂骨膜瓣转移修复指骨骨不连的应用解剖

Applied anatomy on repairing the nonunion of phalanx with vascularized periosteal flap pedicled with proper palmar digital arteries

目的:为设计指掌侧固有动脉蒂近节指骨骨膜瓣转移修复指骨骨不连提供解剖学依据。方法:7例手部标本逐层解剖观察指骨骨膜动脉的来源与分布,并测量相关数据。结果:指掌侧固有动脉在近、中节指骨每侧均发出两条较为恒定的骨膜支,骨膜血管向对侧走行与对侧骨膜支相互吻合成网状,并与肌腱筋膜血管形成交通支,血运丰富。近节指骨近端骨膜支(除拇指外)外径为:(0.54±0.07)mm,如旋转点定在中节指骨基底部,近端骨膜支到旋转点距离(31.83±4.24)mm,旋转点到指端距离(36.00±3.88)mm。结论:指掌侧固有动脉蒂近节指骨骨膜瓣逆行转移是修复手指中、远节指骨骨不连的理想方法。

Objoetive： To provide anatomic basis for transposition of vascularized periosteal flap pedicled with proper palmar digital arteries to repair the nonunion of phalanx. Methods： 7 adult upper limb specimens perfused with red latex were dissected. The source, diameter, course, branches and distribution of periosteal artery of phalanges of each hand were observed and measured. Results： Two periosteal branches of proper palmar digital arteries coursed through the lateral sides of middle and proximal phalanx, and formed vascular net with each other, and communicating ramus with the vessels of tendinous fascia. Therefore the blood supply of periost was rich. The external diameter of proximal periosteal artery of the proximal phalanx was about （0.54±0.07）mm. The distance between peduncle of periosteal artery and the swivel point, the swivel point and the finger tip was about （31.83±4.24）mm and （36.00±3.88）mm respectively. Conclusions： The retrograde transposition ofvascularized periosteal flap pedicled with proper palmar digital arteries is a valuable method to repair the nonunion of middle and distal phalanx.