顾玉东 张高孟 陈德松 成效敏 徐建光 王欢 200040 上海医科大学附属华山医院手外科 中华手外科杂志 1999 0 15 2


    关键词：组织移植；血管；趾；分类法 期刊 zhswkzz 0 拇手指再造 fur -->


    

【摘要】 目的 分析304例足趾移植病例的血管形态,并提出其分型标准及临床意义。 方法 对304例足趾移植中第一跖骨背动脉(动脉系统)的解剖位置、口径及其在趾蹼部的分支情况进行分类。 对200例足趾移植中趾背静脉的回流情况(静脉系统)进行分类。 结果 (1)第一跖骨背动脉的分型：A.按解剖位置分：①浅表型58例，占19.08 %; ②肌内型172例，占56.58 %; ③肌下型74例，占24.34 %; ④缺如型16例,占总数的 5 %(16/320,未统计在304例中)。 B.按口径分：①大型：口径大于1.5 mm,共50例占16.44 %；②中型:在1.5 ～ 1.0 mm之间,共193例占63.49 %;③小型:小于1 mm,共61例占20.07 %。 C.按趾蹼处分支情况分：①分叉型:共266例占87.50 %;②主干型:共11例占3.62 %;③细支型:共27例占8.88 %。 (2)趾背静脉回流情况：分4类：①大隐静脉主干回流型:187例占 93.5 %；②大隐静脉细支回流型:3例占1.5 %；③趾背静脉主干回流型:6 例占3 %；④趾背静脉细支回流型:4 例占2 %。 结论 足趾移植中第一跖骨背动脉变异多,其分型需根据解剖位置、口径及在趾蹼处分支情况等资料, 全方位的综合分析后进行，方有利于指导手术方案的制定。

Types of vascularity in toe transplantation and its clinical significance

GU Yudong, ZHANG Gaomeng, CHEN Desong,et al. Department of Hand Surgery,Huashan Hospital,Shanghai Medical University,Shanghai 200040

【 Abstract】 Objective The vascularity of 320 cases of toe transplantation was analyzed to put forward the critceria and method for classification. Methods (1)The first dorsal metatarsal artery(FDMA) in 320 cases of toe transplantation was dissected and categorized according to its location,diameter and branching pattern at the toe web;(2)The anatomical details of the venous drainage in 200 cases were analyzed and the venous structure was classified accordingly. Results (1)The artery system:(A)According to the location of FDMA,the arterial vascularity was classified as superficial type with a percentage of 19.08;intramuscular type,with a percentage of 56.58;inframuscular type,with a percentage of 24.34; and absent type,with a percentage of 5. (B)According to the diameter of FDMA,it was classified into large( > 1.5 mm ),medium( 1.0 ～ 1.5 mm ),and small( < 1.0 mm ) types,accounting for 16.44 %,63.49 %and 20.07 % of the series respectively.(C)Based on the branching pattern of FDMA at the first toe web, the artery was classified into three types with respect to the second toe: ramifying type for 87.5 %,main trunk type for 3.62 %,and fine small branch type for 8.88 %. (2) The venous return of the second toe could be classified into four types: greater saphenous vein main trunk type, greater saphenous vein small branch type, dorsal digital vein main trunk type, and dorsal digital vein small branch type;constituting 93.5 %,1.5 %, 3 % and 2 % respectively. Conclusions Variations of the first dorsal metatarsal artery are commom in toe transplantation.Dissection and classification should be done according to its location,diameter and branching pattern at the toe web.

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