通过CTA行腋动脉体外定位及其分支起源分型的研究

Localization of axillary artery on body surface and origin and classification of its branches based on CTA

目的通过计算机断层扫描血管成像技术(computed tomography angiography,CTA)为临床提供腋动脉解剖学的影像数据,确定腋动脉体外定位的方式。方法收集2020年7~11月在我院行头颈部CTA患者影像数据,共纳入456侧(228例),通过三维重建观测259侧腋动脉与锁骨、喙突及体表的距离及位置关系;149侧腋动脉及其分支的起源及分型。结果腋动脉起点至锁骨后缘的垂线及锁骨中线的距离分别为(16.9±5.3)mm和(11.9±6.1)mm。喙突下缘的垂线交腋动脉时的长度为(29.4±9.4)mm。喙突下为腋动脉第三段近端。胸上动脉(superior thoracic artery,ST)第一段发出最高49.0%,胸肩峰动脉(thoracoacromial artery,TA)与胸外侧动脉(lateral thoracic artery,LT)于第二段发出最高分别为49.7%与47.7%,肩胛下动脉(subscapularis artery,SS)、旋肱前动脉(anterior humeral circumflex artery,CHA)与旋肱后动脉(posterior humeral circumflex artery,CHP)于第三段发出最高分别为71.1%、11.4%与64.4%。TA、SS、CHP出现率100%,LT出现率96.6%,但其分型最多(4型)。CHA出现率12.1%,肱深动脉(deep brachial artery,DB)单干起源于第三段37.6%。结论平卧、上肢内收,锁骨中线内侧及锁骨后一指、喙突下两指分别可定位腋动脉起点及第三段近端。

Objective To determine the localization of axillary artery on body surface through computed tomography angiography(CTA),so as to provide imaging data of axillary artery anatomy for clinical treatment.Methods The imaging data of patients undergoing CTA of head and neck in our hospital from July to November in 2020 were collected.A total of 456 sides(228 cases)were initially included,and then 197 sides were excluded due to improper body position.3-D reconstruction was performed on the remaining 259 sides,and the distances as well as position relationship of axillary artery with clavicle,coracoid process and body surface were measured and observed.After the further exclusion of 110 sides with unlocatable axillary arteries,149 sides were finally included;the length and inner diameter of axillary arteries were measured,and the origin and types of branches were observed and analyzed.Results The distance from the starting point of axillary artery to the perpendicular line of the posterior edge of clavicle and to the midclavicular line was 16.9±5.3 mm and 11.9±6.1 mm,respectively.The length of the vertical line of the lower edge of the coracoid process intersecting the axillary artery was 29.4±9.4 mm,and the proximal end of the third segment of the axillary artery lay below the coracoid process.In terms of the branches,the highest frequency of superior thoracic artery(ST)which branched out of the first segment of axillary artery was 49.0%;the thoracoacromial artery(TA)and lateral thoracic artery(LT)originated from the second segment,with the highest frequency of 49.7% and 47.7%,respectively;the highest frequencies of subscapularis artery(SS),anterior humeral circumflex artery(CHA)and posterior humeral circumflex artery(CHP)from the third segment were 71.1%,11.4% and 64.4,respectively.The occurrence rate of TA,SS and CHP was all 100%;although that of LT was 96.6%,it presented the most types(4 types).In addition,the occurrence rate of CHA was 12.1%,and that of deep brachial artery(DB)with single stem originated from the third segment was 37.6%.Conclusion In supine position and adduction of the upper limb,the starting point of the axillary artery and the proximal of its third segment can be localized by one fingerbreadth from the medial midclavicular line as well as posterior to the clavicle,and by two fingerbreadths below the coracoid process,respectively.