腘动静脉介入应用解剖学研究及临床意义

THE APPLIED ANATOMY FOR PUNCTURE OF POPLITEAL ARTERY AND VEIN AND ITS CLINICAL SIGNIFICANCE

目的 :为动脉、静脉顺、逆行穿刺提供解剖学依据。方法 :在 2 1具经福尔马林固定的成人尸体标本上 (男 1 4具 ;女 7具 )观察了胫神经血管鞘的位置关系 ;动脉、静脉的伴行关系及管径 ;首次以股骨下端连线为标志测量了有关长度和距离 ( cm)。结果 :( 1 )胫神经在窝上部位于血管鞘外侧 ,在中部与血管鞘前后重叠 ,在下部则位于血管鞘内侧。 ( 2 )动、静脉由上而下的伴行关系可分为两型。 型 :先并列后重叠再并列 ,占 73.81 %。 型 :先重叠后并列 ,占 2 6.1 9%。 ( 3)血管直径及上方并列段有关数值 :动脉上端直径 ( cm) :男 0 .73± 0 .1 9,女 0 .64± 0 .1 9。动脉下端直径 :男 0 .54± 0 .1 1 ,女 0 .52± 0 .1 2 ;静脉上端直径 :男 0 .92± 0 .1 5,女 0 .72± 0 .1 9;上方并列段长度 :男 5.0 7± 2 .0 5,女 5.80± 2 .63。到标志线距离 :最高点 男 1 1 .94± 1 .70 ,女 1 0 .99± 1 .62 ;中位点 男 9.30± 1 .75,女 8.0 9± 1 .59;最低点 男 6.69± 2 .2 2 ,女5.1 8± 2 .43。结论 :后入路的动、静脉穿刺只适于 型。结合上方并列段的有关数值可在动脉的体表投影上准确确定穿刺点的位置。

Objective:To provide a natomic basis for ortho-and antidromic p uncture of popliteal artery and vein.Methods:On 21 adult cadavers(42 si des,male 14 cases and female 7 cases),th e concomitant relationship of tibial ner ve and popliteal vessel sheath,popliteal artery,and vein and the diameter were o bserved.And for the first time length an d distance(cm)relate to popliteal vessel es were measured which take the line thr ough the distal ends of femur as a marke r.Results:(1)The tibial nerve r uns laterally,superficially,medially to the popliteal vessel sheath in the upper ,middle and lower part of popliteal foss a.(2)From above downward the concomitant relationship of popliteal artey and vei n could be classified into two types,the first type apposition-overlapping-appos ition(73.81%),and the second one overlappi ng-apposition(26.19%).(3)The diameters of p opliteal artery were 0.73±0.19(male),0.64±0.19( female)on the top and 0.54±0.11(male),0.52±0.12( female)at the end and on the veins top the diameters were 0.92±0.15(male) and 0.72±0.1 9(female).The length of the upper apposit ion part were 5.07±2.05(male) and 5.08±2.63(fem ale).And the distance to the marker line from highest,middle,lowest point of the upper apposition part were 11.94±1.70(male) ,10.99±1.62(female);9.30±1.75(male),8.09±1.59(female );6.69±2.22(male),5.18±2.43(female).Conclusi ons:Puncture of the popliteal artery and vein at the back is only suitable f or the first type.The percutancous point could be determined accurately on the s urface projection of the popliteal arter y,combined with the data relate to the u pper apposition part.