第二跖背动脉的应用解剖学研究

Applied microanatomical study on the second dorsal metatarsal artery

目的 为应用足背动脉一个吻合口提供两套血供 (第一、第二跖背动脉 )给第二趾移植的解剖学依据。方法 在放大 5倍显微镜下 ,对 10 0例 2 0 0侧新鲜尸体的第二跖背动脉进行显微解剖学研究。结果 ( 1)第二跖背动脉按解剖位置及动脉起始点 ( D1 )及与交通支吻合后 ( D2 )两者口径分为四型二类。 型(浅表型 ) :69例 ,占 3 4.5 % ;口径 1.4 4± 0 .3 2 mm。 型 (肌内型 ) :72例 ,占 3 6%。 型 a类 ( D1 >D2 ) :64例 ,占 3 2 %。 型 b类 ( D1 <D2 ) :8例 ,占 4 % ;。 型 (肌下型 ) :4 3例 ,占 2 1.5 %。 型 a类 ( D1 >D2 ) :3 7例 ,占 18.5 %。 型 b类 ( D1 <D2 ) :6例 ,占 3 %。 型 (缺如型 ) :16侧 ,占 8%。 ( 2 )按口径分 :小支型 :小于 1mm 2 7例 ,占 14 .67%。正常型 :大于 1mm 15 7例 ,占 85 .3 3 %。 ( 3 )按趾蹼处分支情况分 :分叉型 :179例 ,占 97.2 8%。主干型 :4例 ,占 2 .17%。细支型 :1例 ,占 0 .5 4 %。结论 以足背动脉为蒂连同第二跖背动脉一起取下第二足趾时 ,可通过第一、第二跖背动脉提供两套血供的机率为92 %。

Objective To study the microanatomy of the second dorsal metatarsal artery, and provide anatomical basis for applying “two set” blood supply (first dorsal metatarsal artery and second dorsal metatarsal artery) via one anastomotic site in second toe transfer. Methods 200 feet of 100 adult fresh cadavers were dissected under 5 × loupe magnification. The course and diameter of the second dorsal metatarsal artery were observed. Results (1) The second dorsal metatarsal artery was classified into 4 types and 2 subtypes according to its location and the diameter at the initial site (D 1) and at the site joined by the perforating branch (D 2): type I(superficial, diameter 1 44 ± 0 32 mm), type Ⅱa (intramuscular, D 1a (intramuscular, D 1> D 2),type Ⅱb (intramuscular, D 1b (intramuscular, D 1< D 2), type Ⅲa (inframuscular, D 1a (inframuscular, D 1> D 2, type Ⅲb(inframuscular, D 1b(inframuscular, D 1< D 2), and type Ⅳ (absent). There were 69 cases in type I, accounting for 34 5 % ; 72 cases in type Ⅱ, accounting for 36 %; 64 cases in type Ⅱa , accounting for 32 %; 8 cases in type Ⅱb , accounting for 4 %; 43 cases in type Ⅲ, accounting for 21 5 %; 37 cases in type Ⅲa , accounting for 18.5 % ; 6 cases in type Ⅲb , accountinf for 3 %; and 16 cases in type Ⅳ, accounting for 8 %. (2) According to its diameter, the second dorsal metatarsal artery was divided into small branch type where the diameter was smaller than 1 mm and normal type where the diameter was larger than 1 mm. 27 cases were categorized as small branch type, accounting for 14 67 %, whereas 157 cases were normal type accounting for 85.33 %. (3) Based on the branching pattern at toe web, the second dorsal metatarsal artery was classified as ramifying type: 179 cases and 97.28 %, main trunk type: 4 cases and 2.17 %, and fine branch type: 1 case and 0.54 %. Conclusions In second toe transfer, the incidence of taking the first and second dorsal metatarsal artery with the dorsalis pedis artery for “two set” blood supply was 92 %