摘要
目的:通过尸头标本的解剖及观测,了解颏下动脉二腹肌前腹下颌骨骨膜瓣的血运,供血动脉的走行,骨膜瓣的长度,旋转度,面积等指标,掌握该骨膜瓣可修复范围,为临床喉及气管修复研究做好技术及理论上的准备。
方法:选用经10%福尔马林固定的成人湿性尸头标本8例(16侧),男女不限,经尸头灌注及解剖,对颏下动脉,颏下动静脉,二腹肌前腹,下颌骨骨膜瓣进行观测。1例新鲜标本经颏下动脉注入红墨水观察下颌骨骨膜的着色面积。
结果:通过对8例(16侧)尸头标本经解剖测量获得该骨膜瓣的详细数据资料包括其供血动脉--颏下动脉起点、外径、全长及分支的具体数据;颏下静脉的走行,长度,直径;二腹肌形态特点及神经的支配;二腹肌前腹附着处骨膜面积及颏下动脉二腹肌支分布于下颌骨骨膜的面积;骨膜瓣的旋转度、骨膜瓣的着色面积,对该骨膜瓣有了系统的了解。
结论:
1.颏下动脉二腹肌前腹下颌骨骨膜瓣的特点为旋转范围大,修复范围广,肌和肌腱长近5cm向下旋转可修复到环状软骨水。
2.颏下动脉二腹肌前腹下颌骨骨膜瓣骨膜瓣面积相对较大,由于二腹肌是以30°角起于下颌骨二腹肌窝内这样所附着的骨膜面积是肌肉横截面积的一倍。
3.血供充分恒定:颏下动脉及二腹肌前腹支动脉恒定出现可以保证骨膜瓣的成活。
所以颏下动脉二腹肌前腹下颌骨骨膜瓣为修复喉气管缺损的良好皮瓣。
The laryngeal carcinoma is the most familiar malignant tumor in otorhinolaryngology head and neck surgery,accounting for 1%-2%of the whole body tumor around in our country.The incidence of the disease is the toppest in the northeast of our courty and goes up year by year during the last fifty years in the world. due to lesions involving pronunciation, swallowing, breathing, reflective features a serious threat to human health Laryngeal function and long-term loss of tracheal fistula so that the groups significantly decreased quality of life, functional reconstruction after throat surgery has been ENT head and neck surgeon eager to solve the problem and focus attention. At present clinical reports of repair methods has its shortcomings, I hope to find a rotation range, a wide range of repair, and a good constant blood supply, and repair of the larynx and trachea in the same field, an operation can be completed, Smart flap for reconstruction of laryngeal function from the scope of tumor effects of flexible, easy-flap. According to past under the chin of a flap, under the chin of the two abdominal artery before Fuxia jaw flap. To understand the flap of the larynx and trachea and repair the possibility, we have studied and measured eight (16 sides) of the formalin-fixed specimens of adult head and neck, head latex body perfusion. Measurement tools measur the two abdominal muscles before the morphological features, Periosteal flap length of the feeding arteries, the occurrence rate, diameter, branch, accompanied vein, the mandible and the size of periosteal flap of the rotation , and other related anatomical structures, the survey results to mean Average±standard deviation (±s). The following results: in the experimental observation after reperfusion was no chin artery absence of the phenomenon,100% (16 side) Submental artery from the facial artery from a distance of the starting point is 26.70±0.62mm is (15.40-40.00mm), from the mandible Margin is 6.51±2.75mm (3.25-9.42mm), the initial chin artery diameter is 0.92±0.22 (mm) (0.60-1.34mm), the main artery chin length is 49.06±7.86 mm (32.20-60.20 mm) , and its branches, including:①submandibular gland Support: 2 to 4, distributed in the submandibular gland.②sublingual gland Support: sublingual gland blood supply nourishment.③cutaneous branch: 3 ~ 6, distributed in the area under the chin skin.④anastomosis branch: sublingual artery, the artery lower lip, chin chin artery and the contralateral branch of the artery anastomosis.⑤muscular branches: distributed in the platysma, mylohyoid muscle, hyoid tongue, and two former abdominal muscles, the abdominal muscles before with a rate of 100% (16 sides), under the chin to the abdominal artery Support abdominal muscle before a distance of 23.95±3.93 (mm) (15.20 -29.15), the initial diameter is 0.78±0.25 (mm) (0.30-1.28).⑥mandible periosteal branches: from mental artery directly issued or two muscle-issued, located in the mandible periosteum 1 ~ 2, located in the mandible periosteum, 14 in two side mandible periosteal branches, accounting for about 88 %. Mandibular periosteal branches proximal diameter is 0.67±0.27 (mm) (0.22-1.26), the distal mandibular periosteal diameter is 0.59±0.26 (mm) (0.20-1.15), periosteal branches on both sides between the proximal a wide range of anastomosis, in the abdominal muscles before the deep surface to pass through two terminals are generally sticks to the lower jaw to the periosteum blood dependent, as under the chin on both sides of the artery anastomosis, the actual scope. Chin vein of the experimental group were observed, chin vein occurrence rate was 100% (16 side),the diameter into the vein is 1.91±1.28 (mm) (0.8 ~ 3.20mm) submental vein Traveling available following data as a reference from the edge of the mandible from 9.86±5.60mm (3.02-21.30mm), usually with constant mental artery accompanied, in the common course of the submandibular gland, or between the two surfaces. Submental venous anatomy course of the import of venous reflux veins usually have one to two, with the chin artery vein closely with about 80% (16 cases), will work closely with intravenous and non-intravenous closely with the both general-traffic between each other traffic. Morphological characteristics of abdominal: abdominal muscles before a semi-spindle, the abdominal muscles before the 23-50 mm in length, with a mean of 37.20 mm, muscle and tendon length of 47.01±3.19mm (41-52mm ), 9.91±1.16mm in width (8.02- 14.20 mm), the largest cross sectional area of muscle 68.82±18.61 mm2 (38.90-101.60mm 2). The cross sectional area of muscle minimum 5.29±1.27mm2 (2.80-7.60mm2). The abdominal muscles before to 31.7°±3.5°(26°-38°) from the angle of the mandible midpoint of the two sides within the abdominal Waterloo. The abdominal blood supply: The main artery supplying the chin before the abdominal muscles to support the supply, the muscle-occurrence rate was 100%, chin artery to the abdominal muscles before with a distance of 23.95±3.93(mm)(15.20-37.40 mm ), the initial diameter is 0.78±0.25 (mm) (0.30-1.28mm). The abdominal muscles before the periosteum attachment area of 63.8-169.4 (109.4±30.2 mm2), including one case of fresh specimens with the two abdominal artery perfusion measurement in the area of ink 4.28 mm×1.40 mm. Samples of the analog design, this pedicle flap can be rotated to the cricoid cartilage, or head slightly buckling slightly to the contralateral, the flap can be extended to 5, 6 tracheal rings. Conclusion: The flap features of the rotation, repair a wide range of muscle and tendon near 5 cm long downward rotation repairable if the first level of the cricoid cartilage or buckling to the contralateral rotation can flap of the following 5,6 tracheal rings. In the same field. Periosteal flap of a large area, due to the abdominal 31.7±3.51o on the angle of the mandible from the pack in Waterloo, so the area is attached to the periosteum cross sectional area of muscle doubled. Blood for the full constant and can ensure the survival of periosteal flap, submental two abdominal artery before Fuxia jaw flap for the repair of the defect laryngotracheal good flap.
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