摘要
目的探索采用外踝前静脉网移植修复掌浅弓的解剖学依据，并报告其修复掌浅弓缺损的临床疗效。方法取6例新鲜中国成人下肢标本进行显微外科解剖研究，观察和测量外踝前静脉网的分支、分布、血管长度、口径及其瓣膜。临床上自2（107年5月至2017年2月，应用外踝前静脉网移植修复手部掌浅弓缺损患者15例。结果解剖学研究，在外踝前的浅筋膜层存在明显可见的网状静脉，远端来源于足背静脉弓腓侧端，近端于内侧、外侧分别汇人大隐静脉和小隐静脉，其间有4-6条细小静脉构成交汇的网格。小隐静脉足背远侧段（Bc）长度平均（2．81±0．39）cm；外踝前静脉网段分支长度（CD段）平均（5．32±0．92）cm。足背静脉弓腓侧端口径平均（2．15±0．35）mm；网的近端有分支数目平均4．8支，于外踝尖部E线水平分支口径平均（1．06±0．43）mm；每例外踝前静脉网平均存在4．2个瓣膜，分支内瓣膜均朝向近端。临床上，15例掌浅弓缺损患者采用外踝前静脉网移植修复，受区远端共吻合54个，每例远端平均3．6个。术后除1例拇指末节部分坏死外，其余远端手指均完全存活，术后12例随访6个月至5年3个月，手部外形好，恢复了握持和对掌功能，手指阪复本体感觉，两点分辨觉5～7mm。按中华医学会手外科学会上肢功能评定试用标准：优6例，良4例，可1例，差1例。供区无功能影响。结论外踝前静脉网解剖恒定，其形态、管径、分支数目与掌浅弓相近，静脉瓣膜开口朝向近端，是修复掌浅弓缺损的理想方法。
Objective To explore the anatomic basis of anterior lateral malleolar venous network graft for repair of superficial palmar arch defects and report its clinical efficacy. Methods Microsurgical anatomical study was performed in 6 specimens of fresh Chinese adult lower extremities to observe and measure the branches, distribution, vessel length, caliber and venous valve characteristics of the anterior lateral malleolar venous network. From May 2007 to February 2017, 15 patients with superficial palmar arch defects were treated by anterior lateral malleolar venous network graft. Results Anatomical study results showed that there was a obviously visible venous network in the superficial fascia of the anterior lateral malleolus. The distal end was originated from the fibular side of the arcus venosus dorsalis pedis, and the proximal vessels flowed into the great saphenous vein medially and the small saphenous vein laterally. Between them, there were 4 to 6 fine veins that formed network. The length of the distal dorsal segment of small saphenous vein （BC） was （2.81±0.39） cm. The branch length of the anterior lateral malleolar venous network （CD） was （5.32±0.92） cm. The fibular side vascular diameter of arcus venosus dorsalis pedis was （2.15±0.35） mm. The proximal end of the vascular network had 4.8 branches. The diameter of the vascular branch at the tip of the lateral malleolus E line horizon averaged （1.06±0.43） mm. There are an average of 4.2 valves per anterior lateral malleolar venous network. The valves in branches are toward the proximal direction. Clinically, 15 cases of superficial palmar arch defects were treated by anterior lateral malleolar venous network graft with a total of 54 anastomosis sites of distal area of recipient area and an average of 3.6 anastomosis sites per case. Postoperatively, 1 ease suffered partial distal thumb necrosis and the rest of the distal fmgers survived uneventfully. The follow-up time ranged from 6 months to 5 years and 3 months in 12 cases. The ap
作者
于胜军
付胜强
李晓
马振杰
侯忠军
王志龙
高飞
季远
毕本军
Yu Shengjun;Fu Shengqiang;Li Xiao;Ma Zhenjie;Hou Zhongjun;Wang Zhilong;Gao Fei;Ji Yuan;Bi Benjun(Department of Hand Surgery,Yantai Mountain hospital,Yantai 264001,China)
出处
《中华手外科杂志》
CSCD
北大核心
2018年第4期285-288,共4页
Chinese Journal of Hand Surgery
基金
山东省医药卫生科技发展计划项目（2014WS0261）
烟台市科技计划项目（2014WS032）
关键词
解剖
血管移植
静脉网
掌浅弓
Dissection
Vascular grafting
Venous network
Superficial palmar arch
