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目的研究背阔肌重要血管、神经及优势穿支血管的定位范围、大小,为临床设计背阔肌皮瓣及穿支皮瓣提供相应的解剖学依据,缩短寻找相应血管的时间,优化皮瓣设计。方法传统解剖组,对12具24侧(男10、女2)红色乳胶灌注成人标本的背阔肌进行解剖,在直视和手术显微镜下对胸背血管及背阔肌优势穿支血管(直径>0.5 mm,下同)、胸背神经的起止、走行、直径进行显微解剖及观测。高频彩超组,运用高频彩超对30例健康志愿者(男25、女5)双侧背阔肌穿支动脉的出肌点位置进行验证和探测,测量胸背动脉及内外侧分支的直径走行,进一步明确其体表投影位置。结果传统解剖组测的胸背动脉及伴行静脉起始处直径分别为(2.51±0.61)mm、(2.72±0.56)mm,肩胛下动脉起点至旋肩胛动脉处、胸背动脉起始点至发出内外侧支分叉处、分叉处至内侧支最远入肌点及外侧支最远入肌点的距离分别为(3.31±0.81)cm、(5.26±1.95)cm、(4.5±1.13)cm、(6.76±1.81)cm。胸背动脉外侧支和内侧支起始处直径分别为(1.53±0.22)mm、(1.560.15)mm,内外侧支伴行静脉分支起始处直径为(1.71±0.16)mm,(1.52±0.24)mm。俯卧位上肢外展90°时胸背动脉起始点投影约为腋中线与第二肋间交点处或肩胛下角外上方约四横指处(笔者一横指约1.8 cm)。胸背动脉内外侧分支处约为腋后线与第四肋下缘交点处。本组24侧标本中共测得外经大于0.5 mm的穿支动脉181支,其中来自胸背动脉分支以上9支,外侧支56支,内侧支49支,发自肋间后动脉67支。腋后线前后一横指与肩胛下角上一横指和下两横指的区域内、T8~T9棘突旁约三至五横指区域内、T10~T11棘突旁约两至三横指区域内、T12~L1棘突旁约两至三横指区域内易寻得穿支血管,上述定位区在高频彩超下能较快探测到理想的穿支血管。结论通过对背阔肌的详细解剖研究对高频彩超探查胸背血管及重要穿支动脉位置、皮瓣的选择、手术操作等具有指导意义。脊柱两旁背阔肌多由肋间动脉直接供应且与胸背动脉的分支存在较广泛吻合,穿支血管较为理想且穿支点位置相对恒定,可作为理想的穿支皮瓣。
Objective To study the localization range and size of important blood vessels, nerves and predominant perforating branches of latissimus dorsi and to provide anatomical basis for the clinical design of latissimus dorsi flap and perforator flap to shorten the time to find the corresponding blood vessel and optimize the flap design. Methods The traditional anatomical group was dissected to dissect the latissimus dorsi muscle of 12 24-sides (male 10 and female 2) red latex infused adult specimens. The dominant thoracodorsal vessels and latissimus dorsi predominant branches (diameter > 0.5 mm, the same below), the beginning and ending of thoracodorsal nerve, walking, diameter, microscopic anatomy and observation. High-frequency ultrasound group, the use of high-frequency color Doppler ultrasound on 30 healthy volunteers (male 25, female 5) bilateral latissimus dorsi muscle perforating artery location and verify the detection of thoracodorsal artery and medial and lateral branches of the diameter Walk, to further clarify its surface projection position. Results The diameters of the thoracodorsal artery and accessory venous artery in the traditional anatomic group were (2.51 ± 0.61) mm and (2.72 ± 0.56) mm, respectively. The starting point of the subscapularis artery to the spinosynovial artery and thoracodorsal artery originated The distances from the bifurcation to the farthest point of the medial branch and the farthest point of the lateral branch were (3.31 ± 0.81) cm, (5.26 ± 1.95) cm, (4.5 ± 1.13) cm , (6.76 ± 1.81) cm. The diameters of the lateral and medial branches of the thoracodorsal artery were (1.53 ± 0.22) mm and (1.560.15) mm, respectively. The diameter of the branch of the medial and lateral branches was (1.71 ± 0.16) mm and (1.52 ± 0.24) mm. Prosthetic upper limb outreach 90 ° when the starting point of the thoracodorsal artery projection is about axillary midline and the second intercostal space at or below the subscapular angle above about four horizontal cross (I a horizontal finger about 1.8 cm). Thoracic artery at the lateral branches of the medial and lateral axillary line and the fourth edge of the lower edge of the intersection. A total of 181 specimens of perforator arteries with a diameter greater than 0.5 mm were obtained from 24 specimens of the group. Among them, 9 were from the thoracodorsal artery branches, 56 were the lateral branches, 49 were the medial branches, and 67 were from the intercostal artery. Axillary line before and after the axillary line and the underside of the scapula and a horizontal cross-refers to the next two cross-finger region, T8 ~ T9 next to the spinous process by about three to five cross-finger region, T10 ~ T11 spinosad about two to three cross-finger Area, T12 ~ L1 spinous process by about two to three cross-section easy to find perforating blood vessels, the positioning area in the high frequency ultrasound can detect the ideal perforating blood vessels. Conclusion The detailed anatomic study of latissimus dorsi can guide the selection of the location of thoracodorsal vessels, the location of important perforators, the choice of flap and the operation procedure in high-frequency ultrasound. The latissimus dorsi on both sides of the spine are mostly supplied directly by the intercostal artery and have a wide anastomosis with the branches of the thoracodorsal artery. The perforator blood vessels are ideal and the location of the perforation is relatively constant, which can be used as the ideal perforator flap.