静脉蒂股骨外侧髁骨膜瓣修复膝关节软骨缺损的应用解剖

Applied anatomy of the periosteal flap of the femoral external condyle pedicled with vein to repair defects in knee articular cartilage

目的 为修复膝关节软骨缺损提供一个新的骨膜瓣供区。方法 在 5 0侧成人下肢标本上 ,解剖观察了膝上外侧血管的起始、行径、分支、分布及与周围血管的吻合 ;对另 3例进行了摹拟手术及静脉逆行灌注。结果 膝上外侧血管在股骨外侧髁上方 (2 5± 0 5 )cm处起自于血管 ,分出升支、横支、降支及浅支。横支、降支分布于股骨外侧髁。横支与膝降血管吻合 ,吻合率为 10 0 % (5 0侧 ) ;浅支与髌周血管环吻合 ,吻合率为 10 0 % (5 0侧 ) ;升支与旋股外侧血管降支吻合 ,吻合率为 92 %(4 6侧 )。上述血管束及分支均包含一条动脉、二条静脉。结论 在股骨外侧髁可以切取以膝上外侧血管横支、浅支或升支静脉为蒂的骨膜瓣 。

Objective To provide a new donor of the periosteal flap to repair defects in knee articular cartilage. Methods The origin,course,branches distributions of the external superior genicular vessels and its anastomosis with the descending genicular vessels,vessels ring around patella and superior descending branch of lateral circumflex femoral vessels were observed on 50 sides of leg specimens,and retrograde injection of the venae comitants with ink at the level of the vien pedicle were done in another 3 sides of fresh leg specimens. Results The external superior genicular vessels originates from popliteal vessels on (2 5±0 5)cm above the femoral condyle and send out the ascending, transverse,descending and superficial branches. The transverse and descending branches distributed to the femoral external condyle; The transverse vessels anastomosis with the descending genicular vessels(100%),superficial branch vessels with vessel ring around patella(100%),and ascending vessels with descending branch vessels of lateral circumflex femoral vessels(92%). In all the vessels a artery and two venae were involved. The retrograde injection of the venae comitantes was fluent,and the periosteal of femoral external condyle was dyed by ink. Conclusion It is usful to repair defects in knee articular cartilage with the periosteal flap of the femoral external condyle pedicled with vein of transverse,superficial and ascending branches of the external superior genicular vessels.