环臂部全长浅筋膜结构的解剖、影像及组织学观察

Anatomical, imaging and histological observations of the circumferential full-length of superficial fascia structure of the upper limb

目的阐述环臂部全长浅筋膜的大体解剖及组织学特征.方法通过解剖新鲜冷冻臂部标本,结合对5位志愿者行MRI、CT血管造影,以及HE染色的方法,观察环臂部全长浅筋膜在上肢不同区域的结构衍化及其与重要血管的位置关系.结果臂部浅筋膜的4层典型结构由浅入深分为皮下浅层脂肪、膜样物、深层脂肪和深筋膜.这4层结构的厚度和分层、融合程度、组织学特征在臂部各水平面、各区域间均存在明显差别,MRI证实浅筋膜的总厚度从肩部到腕部逐渐减少.静脉血管造影显示头静脉全程都走行于浅筋膜的第2层膜样物以下、深筋膜以上.贵要静脉起自手背静脉网始终位于第2层膜样物以下,直到上臂中点下方贵要静脉穿入深筋膜下方.结论深入认识环臂部全长浅筋膜的结构特征为提高动态臂部环形吸脂术的手术安全性及精细化操作提供了重要的理论基础.

Objective To describe the general and histological features of the full-length superficial fascia of the circumferential upper limb. Methods Fresh frozen arm specimens were dissected, and then MRI imaging in vivo, enhanced CT angiography and HE histological staining were used to describe the characteristics of the full-length superficial fascia of the circumferential arm and its relationship with important blood vessels. Results The four typical structures of the superficial fascia of the arm were divided into subcutaneous superficial fat, membrane-like substance, deep fat and deep fascia from superficial to deep. The thickness and stratification, fusion degree and histological characteristics of the superficial fascia of these four layers were obviously different in different levels and regions of the arm. MRI confirmed that the total thickness of superficial fascia gradually decreased from shoulder to wrist. Venography showed that the cephalic vein ran below the second layer of superficial fascia and above the deep fascia. The basilic vein originated from the dorsal vein network of the hand and always lied below the second layer of membranous material until the basilic vein penetrates below the deep fascia of the upper arm. Conclusions The deep understanding of the circumferential full-length of superficial fascia structure of the upper limb provides an important theoretical basis for improving the surgical safety and fine operation for the Dynamic Arm Circumferential Liposuction.