足内在肌的血供与肌瓣设计的解剖学基础

Vascular supply of intrinsic muscles of foot and anatomic basis for muscular flaps design

目的 研究足内在肌的血供为肌瓣的设计提供解剖学基础.方法 ①红色乳胶灌注的下肢标本20侧,解剖并观察足内各动脉的起始部位,测量其管径及其走行、分支、分布情况等.②动脉灌注明胶-氧化铅混悬液的新鲜成人尸体标本10具,解剖取下各足内在肌,拍摄X线片.利用Photoshop与Scion Image对X线影像进行分析处理,观察营养动脉在肌肉的分布、分型及彼此间的吻合情况.结果 解剖发现的23块足内在肌结构上有明显的不同,肌肉平均长度是（66.1±23.2） mm,肌纤维平均长度是（20.2±4.5） mm,每侧足部有63支肌支提供血液,平均每块足内在肌肉（3.2±0.8）支,平均直径（0.8±0.3） mm,供血区域面积的长、宽分别是（2.2±0.8）cm和（0.9±0.4） cm.同时发现有部分肌肉缺失.结论 ①足内在肌的血运丰富,肌支大小,行程不一,具备切取肌瓣或肌骨（膜）瓣的解剖学基础.②其中7块肌肉的主供血动脉粗大且恒定,易于解剖与取瓣,可供临床选用.

Objective To investigate the vascular supply of intrinsic muscles of foot and anatomic basis for muscular flap design. Methods A radiopaque injectate （lead oxide-gelatin mixtures, 26ml/kg） was injected into 10 fresh cadavers. The dissected regions were photographed and each intrinsic muscles on the foot was removed and radiographed. The number, type, diameter of vascular branches of muscles and their distributions were observed. The area of the vascular territory supplied by each source vessel was calculated using Scion Image for WindowsTM software. Results There were significant architectural differences among the intrinsic muscles. The muscles length varied from 22.5mm to 116.2mm [ average, （66. 1 ± 23.2）mm]. The measured fiber length were relatively consistent, ranging from 14.2 mm to 27.5 mm[average, （20. 2 ± 4.5）mm]. There are 63 vascular branches into the 23 foot muscles, each muscle having average branches of 3.2 ± 0.8. The average diameter of branches, the length and width of each vascular territorial area is （0.8±0.3） mm, （2.2 ± 0.8） cm, and （0.9 ± 0.4） cm, respectively. Other findings included that some muscles were not present in some cadavers. Conclusions The blood supply of intrinsic muscles of foot is abundant with different diameter and distributions of branches. There is an anatomic basis for muscular or musculoosseous flap design. There are 7 intrinsic muscles with large and reliable vascular supply which can be chosen as muscular flaps.