以肘网血管为蒂骨膜瓣的应用解剖

Applied Anatomy of the Periosteal Flaps Pedicled with Arteries in the Cubital Network

目的 :为以肘网血管为蒂骨膜瓣移位治疗肘关节周围骨折、骨不连提供解剖学资料 ,优化手术设计。方法 :在 3 4侧经动脉内灌注红色乳胶的成人上肢标本上观察肘关节周围非主干动脉的起源、走行、分布、吻合并测量其起点外径、长度及骨膜瓣可取面积。结果 :中副、桡侧副、尺侧上副、尺侧下副、桡侧返、尺侧返、骨间返动脉的起点外径均在 1mm以上 ;其中桡侧副、尺侧下副、骨间返动脉有骨膜支各供应肱骨下段外侧、肱骨下段内侧、尺骨上段背侧 ;桡侧副、桡侧返、骨间返动脉在肘关节桡侧有恒定的吻合 ,尺侧上副、尺侧下副、尺侧返动脉在肘关节尺侧有恒定的吻合。结论 :①肘网血管在肘关节桡、尺侧吻合恒定 ;②肘关节周围有 3个骨膜瓣供区 ;③各骨膜瓣供区的近端和远端至少有 1支肘网血管供应 ,可向近端或远端移位 ;④肘网血管为蒂骨膜瓣设计多样 。

Objective: To offer the anatomic basis of transposing pedicled periosteal flaps for curing fracture or bone non union around the elbow joint. Methods: The origin, course, distribution and anastomosis of the arteries which form the cubital network were observed on 34 adult upper limb specimens filled with red emulsion in the arteries.The diameter, length of these arteries and the area of the periosteal flaps were measured. Results: The diameters of middle collateral artery(MCA), radial collateral artery(RCA), superior ulnar collateral artery(SUCA), inferior ulnar collateral artery(IUCA), radial recurrent artery(RRA), ulnar recurrent artery(URA), and recurrent interosseous artery(RIA) in the cubital network were all are over 1 mm.There were periosteal branches distributing from RCA to lower lateral humerus, from IUCA to lower medial humerus, and from RIA to proximal dorsol ulna. There are reliable anastomosis among RCA, RRA, RIA on the radial side of the elbow joint and SUCA, IUCA, URA on the ulnar side of the elbow joint. Conclusions: ①The radial and ulnar vessel anastomosis stems are reliable. ②There are three donors of the periosteal flap. ③There is at least a vascular pedicle at both distal and proximal end of each periosteal flap, which can be transposed to distal or proximal site. ④The indications of each kind of periosteal flaps pedicled with arteries in the cubital network should be clarified before clinical applying.