肘肌游离肌瓣重建拇指对掌功能的解剖

doi:10.16098/j.issn.0529-1356.2018.03.014

摘要/Abstract

摘要：

目的通过对肘肌和拇短展肌（APB）的解剖学研究，为肘肌作为游离肌瓣重建拇指对掌功能提供解剖学依据。方法选取8具肘部、前臂部与手部保存完好的尸体标本，使用游标卡尺（精度0.1 mm）和Image J 1.45 d软件测量肘肌与拇短展肌肌肉面积与肌纤维角度，以及支配两者的神经血管长度与直径，以定量描述肌肉结构以及涉及肘肌游离肌瓣重建拇指对掌功能手术规划的神经脉管系统。结果肘肌肌肉纤维长度为(82.0±12.0) mm，拇短展肌肌肉纤维长度为(51.6±8.3) mm；肘肌面积为(937±221) mm²，拇短展肌面积为(704±244) mm²；说明肘肌面积和长度均大于拇短展肌。肘肌和拇短展肌纤维平均角度分别为61°±10°和71°±12°，差异无显著性（P>0.05）。肘肌和拇短展肌神经血管直径分别为：动脉直径（1.16±0.28）/（1.4±0.4）mm, 神经直径（1.7±0.3）/（1.9±0.3）mm，差异无显著性（P>0.05)。肘肌血管蒂（骨间后动脉）的长度（32.0±3.1）mm、直径（1.16±0.28）mm和并行静脉直径0.8 mm足够进行显微吻合术。结论与其他游离肌瓣相比，肘肌在解剖结构、供体并发症等方面优势明显，因此肘肌游离肌瓣进行拇指对掌功能重建十分适宜。

关键词: 肘肌, 拇短展肌, 对掌功能重建, 游离肌瓣, 解剖学测量, 人

Abstract:

Objective To compare the anatomical differences between the anconeus and the abductor pollicis brevis (APB), in order to provide anatomical features of the anconeus for its suitability as the free muscle flap for restoration of thumb oppositional function. Methods Nine Chinese cadavers with elbow, forethigh and plam of hand preserved well were collected. By using standard calipers and Image J 1.45 d, we gave a quantitative description of muscle architecture and the neurovasculature involved in the operative planning of restoration thumb oppositional function in which anconeus free muscle flap is used. Results The mean measures of the anconeus were larger than those of the APB ［anconeus/APB fiber length=(82.0±12.0)mm/(51.6±8.3)mm, area=(936.7±221.8)mm²/(704.4±244.2)mm²］. There was no significant difference between mean fiber angles (anconeus/ APB=60.9°±10.2°/71.2°±11.7°; P>0.05) and neurovasculature ［anconeus/APB:artery diameter=(1.9±0.2)/(2.0±0.5)mm, nerve diameter=(1.7±0.3)/(2.1±0.4)mm; P>0.05］. The length (32.0±3.1)mm and caliber ［diameter=(1.16±0.28)mm］of the vascular pedicle of the anconeus(recurrent posterior interosseous artery) and its venae comitans (diameter=0.8 mm) were sufficient for microsurgical anastomosis. Conclusion The anatomic rationale of the anconeus free muscle flap for thenar reconstruction is suitable and compared to other free muscle flap. It has some advantages: reliable and matching anatomy, minimal donor site morbidity, and the potential to restore a greater degree of opposition and thus function in a one-stage procedure.

Key words: Anconeus, Abductor pollicis brevis, Restoration of thumb oppositional function, Free flap, Anatomical measurement, Human

高文静史紫堉韩轶锴孙宣锋张峥徐高磊张振华 . 肘肌游离肌瓣重建拇指对掌功能的解剖[J]. 解剖学报, 2018, 49(3): 355-360.

GAO Wen-jing SHI Zi-yu HAN Yi-kai SUN Xuan-feng ZHANG Zheng XU Gao-lei ZHANG Zhen-hua. Anatomy of anconeus free muscle flap for restoration of thumb oppositional function [J]. Acta Anatomica Sinica, 2018, 49(3): 355-360.

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