摘要
目的解剖观察并设计第4腰动脉穿支蒂臀上皮神经营养血管皮瓣。为临床应用提供解剖学、形态学依据。方法解剖成人国人腰臀区标本,观测第4腰动脉后支、臀上皮神经及分支走行、分布区域,在深筋膜穿出点的位置;测量第4腰动脉的后支外径,及臀上皮神经前支的粗壮中间支的长度等数据;在应用解剖学基础上,设计第4腰动脉穿支蒂臀上皮神经营养血管皮瓣并应用于修复骶尾部巨大创面12例。结果第4腰动脉后支穿出深筋膜处外径:(1.16±0.43)mm,30侧中19侧为单干,占63.3%。11例穿出深筋膜前分为2~3支后再穿出深筋膜,占27.7%。臀上皮神经前支的粗壮中间支长度(147.82±16.37)mm。皮瓣可切取范围:上界在旋转点上方2~4 cm,内侧达后正中线,外侧至腋后线,下界至臀中部。皮瓣切取面积17.4cm×12.5cm~25.4cm×18.3cm,皮瓣长宽比:(3~5):1。设计第4腰动脉穿支蒂臀上皮神经营养血管皮瓣修复骶尾部巨大创面12例。皮瓣全部成活,效果满意。结论该皮瓣血供主要来自第4腰动脉后支,臀上皮神经及分支支配,具有一定的规律性和可预测性。此皮瓣设计容易,解剖恒定、清晰,覆盖面积大,手术操作简便,是修复骶尾部巨大创面较理想的方法。
Objective To observe and design the gluteal epithelial neurovascular flap pedicled with perforator of fourth lumbar artery,so as to provide anatomical and morphological basis for the clinical application.Methods Anatomical observation of 15 cases(30 sides)adult Chinese specimen of waist-hip region were performed.The distribution of posterior branch of the fourth lumbar artery,gluteal epithelial nerve and its subdivision branch were observed at the position of deep fascial perforation point.Measure The outer diameter of the posterior branch of the fourth lumbar artery,and the length of middle branch of the gluteal epithelial nerve were measured.On the basis of applied anatomy,the gluteal epithelial neurovascular flap pedicled with perforator of fourth lumbar artery was designed and applied to repair huge wounds in sacrococcygeal tracts in 12 cases.Results The external diameter of the fourth lumbar artery's posterior branch penetrated the deep fascia was(1.16±0.43)mm,with 63.3%represented by single branches in 19 out of 30 instances.In 11 cases,the artery was divided into 2~3 branches before penetrating the deep fascia,accounting for 27.7%.The length of the intermediate branch of gluteal epithelial nerves was(147.82±16.37)mm.The design area of the gluteal fascial flap were the following the superior boundary was 2~4 cm from the rotation point,the inferior boundary was the superior part of the gluteus maximus,the inside of superior boundary was the posterior median line,the lateral side was posterior axillary line.The flap size was 17.4 cm×12.5 cm~25.4 cm×18.3 cm.Length-width ratio of the flap was(3~5):1.Twelve cases of large sacrococcygeal wounds were repaired by the 4th lumbar artery perforated gluteal neurotrophic vascular flap.All the flaps survived and the effects were satisfactory.Conclusions The blood supply of the flap is mainly from the posterior branch of the fourth lumbar artery,the gluteal epithelial nerve and its branch innervation,which has certain regularity and predictability.This flap is easy to design,constant and clear anatomy,covers a large area,and is easy to operate,making it an ideal method for repairing huge wounds in the sacrococcygealgeal.
作者
吴富章
张鹏礼
章振华
何永兵
郭涛
孙和炎
Wu Fuzhang;Zhang Pengi;Zhang Zhenhua;He Yongbin;Guo Tao;Sun Heyan(Department of Orthopedics,Anhui Provincial Corps Hospital,Chinese Peoples Armed Police Force,Hefei 230041,China;Department of Orthopedics,the First Affiliated Hospital of Anhui Medical University,Hefei 230001,China)
出处
《中国临床解剖学杂志》
CSCD
北大核心
2024年第4期406-410,418,共6页
Chinese Journal of Clinical Anatomy
基金
安徽省“十三五”医疗卫生重点专科建设项目(皖卫科教秘[2021]230号)
安徽中医药大学临床重点项目(2024LC056)
安徽省自然科学基金项目计划(2008085MH291)。
关键词
臀上皮神经营养血管皮瓣
第4腰动脉
解剖观察
创面修复
Gluteal epithelial neurovascular flap
Fourth lumbar artery
Anatomical observation
Wound repair
