旋肱后血管为蒂肱骨骨膜瓣移位的应用解剖

Applied anatomy of transposition of humeral periosteal flap pedicled with posterior humeral circumflex artery

目的 :为肱骨头缺血性坏死提供一种新的显微外科修复方法。方法 :在 3 2侧经动脉内灌注红色乳胶的成人上肢标本上 ,解剖观测了旋肱后动脉的起始、走行、分支、分布及吻合情况 ,设计了以旋肱后血管为蒂肱骨骨膜瓣移位术。结果 :旋肱后动脉在出四边孔即距肱骨大结节顶点下 5 .6± 0 .9cm处发大结节骨膜支和三角肌肌支 ,本干循肱骨外科颈后面向前行并与旋肱前动脉吻合。大结节骨膜支起点管径为 1.2± 0 .2mm ,向大结节顶点走行 ,沿途分 4～ 5条侧支呈扇形分布于大结节后外侧面骨膜 ,供骨面积可达 3 .0cm× 5 .0cm。结论 :以旋肱后血管为蒂肱骨骨膜瓣移位可用于修复肱骨头缺血坏死 ,方法简便实用。

Objective:To provide a new therapeutic method for ischemic necrosis of humeral head.Methods:The origin,course,branches,distribution and anastomosis of the posterior humeral circumflex artery were observed on 32 adult cadaver upper limb specimens perfused with red latex,and the transposition of humeral periosteal flap pedicled with posterior humeral circumflex artery was designed.Results:The posterior humeral circumfles artery gave off greater tubercle periosteal branch and deltoid muscle branch at 5.6±0.9 cm under top of humeral greater tubercle after penetrating quadrilateral foramen.The main stem went along the surgical neck and anastomosed with anterior humeral circumflex artery.The originated diameter of greater tubercle periosteal branch is 1.2±0.2 mm and the vessel gave off 4～5 rami to the lateral periosteum of great tubercle with a sector distribution along its way to top of great tubercle.The maximum harvest periosteum could reach 3.0 cm×5.0 cm.Conclusion:Transposition of humeral periosteal flap pedicled with posterior humeral circumflex artery is an easy practical method to repair ischemic necrosis.