游离骨间后动脉3叶皮瓣设计的解剖学研究

The applied anatomy of the design of the free tripaddle flap on the pedicle of the posterior interosseous artery

目的 为临床设计以骨间后血管为蒂的游离3叶皮瓣提供解剖学依据。方法 新鲜前臂标本8侧,以肱骨外上髁至尺骨茎突桡侧连线为轴线,将前臂划分为4个均等区间,解剖观察远端3个区间中骨间后动脉发出的穿支的位置、走形和分支数,在深筋膜浅层和深层的穿支蒂长度。选取1例标本进行3叶皮瓣设计切取模拟手术。结果 骨间后动脉在前臂平均发出4-7个穿支,其中区间Ⅰ穿支数为2-4个,区间Ⅱ穿支数为2-3个,区间Ⅲ穿支数平均为1-3个;区间Ⅰ、Ⅱ、Ⅲ穿支起点到深筋膜的蒂长分别为0-0.6、0.2-1.2、0.5-1.8 cm,穿支起点到浅筋膜层的蒂长分别为1.2-2.7、1.2-4.5、1.8-4.5 cm。结论以骨间后动脉为蒂,利用其不同部位的穿支组合,设计游离3叶皮瓣具有临床可行性。

Objective To provide the anatomical basis for the design of the tripaddle flap on the posterior interosseous artery （PIA）. Methods Eight cadaveric forearms were used for this study. A line was drawn representing the axial line from the lateral epicondyle of the humerus to the radial side of the ulnar styloid on the dorsal forearm. The dissection was applied in distal three segments for the peforators of the PIA. The following contents were investigated： the position and the number of the perforators; the course of the perforator; the length of the pedicle of perforators dissected from the underneath layer of the deep fascia and the superficial layer of the deep fascia. One cadaveric was used to imitate the harvest tripaddle PIA flap. Results The PIA gave off 4 to 7 perforators, and the range number of perforators in segment Ⅰ, Ⅱ and Ⅲ was from 2 to 4, 2 to 3, and 1 to 3, respectively. The range of the pedicle length of perforators dissected from the underneath layer of the deep fascia was from 0 to 0.6 cm, 0.2 to 1.2 cm, 0.5 to 1.8 cm, respectively. The range of the pedicle length of perforators dissected from the superficial layer of the deep fascia was from 1.2 to 2.7 cm, 1.2 to 4.5 cm and 1.8 to 4.5 cm, respectively. Conclusion The perforators at the different segments of the PIA can be used to design the tripaddle flaps.