股外侧肌浅区解剖及其临床意义初步研究

Preliminary study on anatomy and clinical significance of the superficial region of lateral femoral muscle

目的通过股外侧肌浅区的解剖,探讨采用股外侧肌浅区肌肉进行动力重建的可行性。方法2020年3月-2022年12月,西安凤城医院手足显微外科通过尸体解剖2例4侧,术中观察和测量21例21侧,对股外侧肌浅区肌肉的大体形态及厚度、肌肉长度、宽度、肌纤维长度、肌肉表面肌纤维羽状角等结构进行测量,并对血管、神经在肌肉内的走行进行解剖和测量。结果尸体解剖发现股外侧肌浅区呈梭形,近端为膜部,远端是肌肉部分,起于大转子,止于髌骨及股直肌;膜的下面肌纤维依次排列起于此处并自上而下止于深筋膜;肌肉表面肌纤维羽状角为(18.9±3.3)°,肌肉厚度为(1.96±0.48)cm;浅区有旋股外侧动脉(LCFA)降支和股神经第2支分布,相互伴行,距入肌点前5.0 cm血管外径(2.39±0.52)mm、神经直径(2.64±0.61)mm;进入肌肉后每隔1.0~1.5 cm,分别向前、后发出分支;神经在入肌点以远0~2.5 cm处,常有1条向后侧走行的较大的分支进入肌肉,4侧标本均出现,术中观察21侧出现率为90.5%,其直径为(1.23±0.28)mm。结论股外侧肌浅区有独立的血管、神经支配,并有多个分支,是形成一部分或多部分肌肉移植的解剖基础。

Objective To explore the feasibility in reconstruction of the muscular power with the superficial part of lateral femoral muscle through anatomical study on the superficial region of lateral femoral muscle.Methods Studies on 4 sides of lower limbs of 2 cadaver specimen were conducted in the Department of Hand and Foot Microsurgery of Xi'an Fengcheng Hospital.Intraoperative observations and measurements were further carried out on 21 sides of 21 patients.Muscular fascia in superficial region,muscular gross morphology,thickness,length and width of muscles,length of muscle fibres and pinnate angles of muscle surface were observed and measured.Both blood vessels and nerves in the muscle were separated to measured.Results The superficial region of lateral femoral muscle was in a shape of fusiform and started from the greater trochanter and ended at the patella and rectus femoris,with the fascia at proximal end and the muscle of distal end.The inferior muscle fibres of the fascia were arranged in sequence and ended at the deep fascia from proximal to distal.Mean muscle thickness was measured at 1.96 cm±0.48 cm,and mean pinnate angle was of 18.9°±3.3°.The superficial region was found being distributed by the descending branches of lateral circumflex femoral artery(LCFA)and the second branch of femoral nerve,and they accompanied each other.At 5.0 cm from the point of entry to the muscle,the diameter of the vessels was measured at 2.39 mm±0.52 mm,and the diameter of nerves was at 2.64 mm±0.61 mm.Both of arteries and nerves further branched out anteriorly and posteriorly in 1.0-1.5 cm intervals after having entered the muscle.At 0-2.5 cm away from the muscle entry point,a larger branch was often running posteriorly into the muscle,and this branch appears on all 4-sided specimens.While the occurrence rate in the 21 sides of patients observed in operations was of 90.5%,with a transverse diameter at 1.23 mm±0.28 mm.Conclusion The superficial region of lateral femoral muscle is dominated by independent vessels and nerves and there are many branches from superior vessels and nerves,which form an anatomical basis for one or more muscular flaps.