应用解剖

第1掌心动脉掌骨颈尺侧穿支的解剖研究及临床意义

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  • 1.山东大学附属省立医院手足外科,  济南   250021; 2.山东第一医科大学附属省立医院手足外科,  济南   250021 
朱明昇(1991-),男,山东枣庄人,在读硕士,主要研究方向:创伤显微外科, E-mail:zms13276498275@163.com

收稿日期: 2022-02-05

  网络出版日期: 2022-05-31

Anatomical study and clinical significance of the first metacarpal artery ulnar perforator branch of metacarpal neck 

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  • 1.Department of Hand and Foot Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China; 2. Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China

Received date: 2022-02-05

  Online published: 2022-05-31

摘要

目的    研究第1掌心动脉掌骨颈尺侧穿支与第2掌背动脉及指蹼动脉间的吻合类型, 为第2掌背动脉皮瓣的安全设计切取提供解剖学基础。 方法    成人新鲜手标本39侧, 用红色乳胶灌注动脉。解剖观测第1掌心动脉掌骨颈尺侧穿支的起源、走行、外径以及与第2掌背动脉和指蹼动脉间的吻合方式。  结果     第1掌心动脉掌骨颈尺侧穿支在第2掌骨颈处起自第1掌心动脉,起始处直径(0.57±0.20)mm,沿第2掌骨颈尺侧和骨间肌的间隙穿向背侧,与第2掌背动脉及指蹼动脉间形成吻合。依其与掌背动脉及指蹼动脉的吻合特点可分4型:Ⅰ.无吻合型(38.46%);Ⅱ. “T” 型(33.33%);Ⅲ. “Y”型(25.64%);IV. “π” 型(2.56%)。 结论    28.20%的第2掌背动脉与指蹼动脉间并非直接吻合,而是通过第1掌心动脉掌骨颈尺侧穿支间接吻合( “Y” 型、 “π” 型吻合),当遇到这两种情况时,术中很容易破坏第2掌背动脉与指蹼动脉间的吻合连续性,导致第2掌背动脉皮瓣的切取困难甚至失败。

本文引用格式

朱明昇, 王增涛, 陈京国, 郝丽文, 陈超, 侯致典 . 第1掌心动脉掌骨颈尺侧穿支的解剖研究及临床意义[J]. 中国临床解剖学杂志, 2022 , 40(3) : 249 -254 . DOI: 10.13418/j.issn.1001-165x.2022.3.01

Abstract

 Objective    To study the anastomotic types between the first metacarpal artery metacarpal neck ulnar perforator, the second dorsal metacarpal artery and the webbed artery, so as to provide anatomical basis for the safe design and incision of the second dorsal metacarpal artery flap.    Methods    A total of 39 fresh adult cadaveric hands were collected. All the arteries of those hands were perfused with red latex. Anatomical observation under the microscope was recorded not only the origin, course, and outer diameter of the first metacarpal artery metacarpal neck ulnar perforator, but also the anastomosis between the second dorsal metacarpal artery and the webbed artery.    Results    The first metacarpal artery metacarpal neck ulnar perforator branch started at the second metacarpal neck from the first metacarpal artery, with an initial diameter of (0.57±0.20) mm, and passed dorsally along the gap between the ulnar side of the second metacarpal artery and the interosseous muscles, forming anastomosis with the second dorsal metacarpal artery and the webbed artery. According to the anastomotic characteristics of the dorsal metacarpal artery and the webbed artery, it could be divided into 4 types: Ⅰ. Non-anastomosis type (accounting for 38.46%); Ⅱ. "T" type (accounting for 33.33%); Ⅲ. "Y" type (accounting for 25.64%); IV. "π" type (accounting for 2.56%). Conclusions   The anastomosis between 28.20% of the second dorsal metacarpal artery and the webbed artery are not direct, but indirectly anastomosed through the first metacarpal artery metacarpal neck ulnar perforator ("Y" type, "π" type anastomosis). In these two cases, it is easy to destroy the anastomotic continuity between the second dorsal metacarpal artery and the webbed artery during the operation, which may cause the difficulty or even failure of the second dorsal metacarpal artery flap operation.

参考文献

[1]  姜永冲, 路来金. 手背逆行岛状皮瓣的应用解剖[J]. 中国临床解剖学杂志, 1991, 9(3):135-137. DOI: CNKI:SUN:ZLJZ.0.1991-03-002.
[2]  Maruyama Y. The reverse dorsal metacarpal flap[J]. Br J Plast Surg, 1990, 43(1):24-27. DOI: 10.1016/0007-1226(90)90041-w. 
[3]  Pelissier P, Casoli V, Bakhach J, et al. Reverse dorsal digital and metacarpal flaps: a review of 27 cases[J]. Plast Reconstr Surg, 1999,103(1):159-165. DOI: 10.1097/00006534-199901000-00025.
[4]  温广明, 徐达传, 姚建民, 等. 第2指蹼动脉吻合类型及其在手背逆行岛状皮瓣中的意义[J]. 中国临床解剖学杂志, 1999, 17(2): 37-39.
[5]  Yu GR, Yuan F, Chang SM, et al. Microsurgical second dorsal metacarpal artery cutaneous and tenocutaneous flap for distal finger reconstruction: anatomic study and clinical application[J]. Microsurg- ery, 2005, 25(1): 30-35. DOI: 10.1002/micr.20077. 
[6]  Quaba A, Davison P. The distally-based dorsal hand flap[J]. Br J Plast Surg, 1990,43(1):28-39. DOI: 10.1016/0007-1226(90)90042-x. 
[7]  Yousif  NJ, Ye Z, Sanger JR, et al. The versatile metacarpal and reverse metacarpal artery flaps in hand surgery[J].Ann Plast Surg, 1992,29(6):523-531. DOI: 10.1097/00000637-199212000-00008. 
[8]  程开明, 侯致典, 王英华, 等. 第二和第三掌背动脉皮支皮瓣的应用解剖[J]. 解剖学研究, 2008,30(3):210-213. DOI: CNKI:SUN:GDJP. 0. 2008-03-013.
[9]  王英华, 王增涛, 李常辉. 掌背动脉皮支皮瓣的临床应用解剖[J]. 山东医药, 2006, 46(15):42-43. DOI: 10.3969/j.issn.1002-266X.2006.15.020.
[10]李旭升, 刘兴炎, 甄平, 等. 逆行第二掌背动脉皮瓣及肌腱皮瓣修复手指皮肤软组织缺损27例[J]. 实用医学杂志, 2010,26(12):2169-2170. DOI: CNKI:SUN:SYYZ.0.2010-12-048.
[11]路来金, 姜永冲, 张巨, 等. 手背逆行岛状皮瓣的临床应用[J]. 中华外科杂志, 1991, 29(10):593-595.
[12]杨焕友, 王斌, 李瑞国, 等. 吻合血管的第二掌背动脉皮瓣修复手指掌侧皮肤伴双侧指固有神经、动脉缺损[J]. 中华手外科杂志, 2021, 37(01):10-12. DOI: 10.3760/cma.j.cn311653-20200303-00094.
[13]林泽金, 吴耿, 邓雪峰, 等. 改良第二掌背动脉复合皮瓣修复示中指背侧缺损[J]. 中国现代手术学杂志, 2019, 23(4):285-288. DOI: CNKI:SUN:XDSS.0.2019-04-013.
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