基于髌骨精确测量的股前外侧皮瓣设计方案的临床解剖

Clinical anatomy on the schematic of anterolateral thigh flap with patella accurate measurement

目的 :探讨基于髌骨精确测量的股前外侧皮瓣设计方案的可行性。方法 :2018年3月至2019年3月湖南省肿瘤医院就诊患者,均采用右侧股前外侧皮瓣修复口腔癌术后缺损。术前精确测量髌骨外下缘与外上缘。髂髌连线为髂前上棘与髌骨外上缘最外侧突出点的连线,作为预测穿支体表定位的解剖标志。同时使用便携式多普勒仪探测穿支的出肌点。术中观察穿支出肌点与髂髌连线的关系,测量穿支血管入阔筋膜点至髂髌连线的垂直距离。结果 :本组研究统计结果显示穿支血管出肌点均出现在髂髌连线附近,髂髌连线为股直肌与股外侧肌肌间隙的体表投影,穿支血管入阔筋膜点均位于以髂髌连线为中心线的内、外侧3.0 cm内。结论 :基于髌骨精确测量的术前设计方案有利于定位股前外侧皮瓣穿支血管出肌点与入阔筋膜点。

Objective:To explore the feasibility of design scheme for anterolateral thigh flap based on accurate measurement of patella.Methods:From March 2018 to March 2019,patients treated in the Hunan Cancer Hospital were treated with right anterolateral thigh flap to repair postoperative defect of oral cancer.The preoperative design based on accurate measurement of lateral superior and inferior rim of patella was performed.The iliac patellar line between iliac spine and the lateral superior rim of patella was connected as an anatomic marker to predict the surface location of the perforating branch.At the same time,portable Doppler instrument was used to detect the muscle outlet of the perforating branch.The relation of muscle outlet of the perforator and the iliac patellar line were observed during the operation.The vertical distance from the fascia outlet to the iliac patellar line was measured.Results:The statistical results of this study showed that the muscle outlet of the perforator were all located near the iliac patellar line,which was the body surface projection of the muscle gap between rectus femoris and lateral femoris muscle,and the points of the perforator vessels entering the fascia lata were all located within bilateral 3.0 cm of the iliac patellar line.Conclusion:The preoperative design based on the accurate measurement of patella is beneficial to locate the muscle outlet and entering fascia lata point of the perforating vessel of anterolateral thigh flap.