贵要静脉的应用解剖

目的为临床上行贵要静脉穿刺术,提高穿刺成功率提供贵要静脉的应用解剖学资料。方法选取经福尔马林浸泡的成人尸体标本33例共66侧。逐层解剖上肢,暴露贵要静脉。用游标卡尺来测量贵要静脉的长度和外径。并观察贵要静脉的起始情况,贵要静脉与相关神经及动脉之间的关系。结果贵要静脉长度,男性约335.01 mm,女性约331.50 mm;贵要静脉在前臂中部管径,男性约1.90 mm,女性约1.85 mm;贵要静脉接肘正中静脉处管径,男性约2.35 mm,女性约2.26 mm;贵要静脉末端管径,男性约2.90 mm,女性约2.60 mm。贵要静脉多数起于手背尺侧缘,少数起于第1手背静脉汇合处,后沿前臂尺侧上行,在肘窝下方转向前面,接收肘正中静脉后,经肱二头肌内侧沟上行至臂中部,穿深筋膜汇入肱静脉。贵要静脉深面是肱二头肌腱膜,此腱膜将贵要静脉与肱动脉、正中神经隔开,贵要静脉可跨过前臂内侧皮神经,前臂内侧皮神经亦可跨过贵要静脉。结论在肘部抽血时,如遇肘正中静脉缺如,以穿刺贵要静脉为宜;穿刺置管时如遇头静脉插管困难,以选择贵要静脉为宜。     

Ⅱ型肌皮神经与桡神经浅支缺如伴低位型正中神经一例

正笔者在解剖1青年男性尸体时发现:其右侧臂丛外侧束先直接发出喙肱肌支、肱二头肌支、肱肌支和前臂外侧皮神经后,再与正中神经内侧根在臂中上部汇合形成正中神经。而前臂外侧皮神经斜越肱二头肌经前臂外侧至手背桡侧,前臂桡神经浅支缺如,现报道如下。     

头静脉变异1例

头静脉汇入腋静脉变异较少见,头静脉汇入腋静脉的属支胸腹壁静脉尚未见报道。作者在解剖一老年男性尸体标本过程中,发现头静脉变异一例,现报道如下。1材料与方法男性尸体标本一例,年龄约60岁,身长167 cm。常规方法解剖显露上肢皮下组织及浅静脉,见右头静脉由掌背侧静脉网起始,绕过前臂桡侧至前臂掌面,向上至肘关节下侧与肘正中静脉和贵要静脉交通,且在此有一浅层分支绕至肱三头肌外侧头与长头之间与上臂的深静脉相通,而不是在前臂与深静脉相通,之后头静脉上升至肱二头肌与肱桡肌之间,经过前臂外侧皮神经浅面,向上循肱二头肌外缘向上,并且在…     

双侧正中神经、肌皮神经变异一例

正笔者在解剖1具女性尸体时,发现双侧肌皮神经、正中神经存在变异(图1),现报道如下。右侧正中神经在臂部伴肱血管走行,位于肱二头肌内侧沟,约在臂部上段与中下段正中神经由外侧发出2个分支,近侧分支沿前外下方走行,到达肱二头肌与喙肱肌并支配上述2肌;远侧分支由正中神经外侧发出,行向外下方到达肱肌并支配该肌。正常情况下正中神经在臂部无分支,在前臂发出肌支,支配除肱桡肌、尺侧腕屈肌和指深屈肌尺侧半以外的前臂所有屈肌;而肱二头肌、喙肱肌与肱肌均受来至臂丛外侧束的肌皮神经支配,但该侧肌皮神经未出现。左侧正中神经由来自外侧束的内侧根与来自内侧束的外侧     

肌皮神经变异1例

肌皮神经自臂丛外侧束发出后,向外侧斜穿喙肱肌,经肱二头肌与肱肌间下行,经肱二头肌下端外侧穿出深筋膜,称为前臂外侧皮神经;正中神经沿肱二头肌内侧沟下行,并由外侧向内侧跨过肱动脉,与该血管一起行至肘窝[1].     

头静脉变异1例

头静脉起自手背静脉网的桡侧,在臂前区,行于肱二头肌外侧沟内,经三角肌胸大肌间沟内穿锁胸筋膜注入腋静脉或锁骨下静脉[1].贵要静脉起自手背静脉网的尺侧,行于肱二头肌内侧沟的下半,穿臂筋膜注入肱静脉或胶静脉.     

双侧非对称性尺浅动脉1例

尺浅动脉是臂和前臂动脉主干变异之一。这种异常的分型及临床意义已有报道。我们将在实习中遇到的1例右侧为高位尺浅动脉,左侧为低位尺浅动脉,报道如下:中年男性标本。右侧尺浅动脉在胸小肌下缘处起自腋动脉,直径2.8ｍｍ,跨过正中神经内、外侧根结合浅层,于肱二头肌内侧沟下行,穿肱二头肌腱膜深层至前臂深筋膜深层,沿前臂肌肉浅层斜行向下内到豌豆骨外侧,直径1.5ｍｍ,于腕掌侧韧带深层进入手掌。左侧尺浅动脉的起点在髁间线以下2.5ｍｍ处起自肱动脉,在前臂行程同右侧(图1)。左侧腋动脉于正中神经内、外侧根结合处浅层向作者单位:266021　青…     

肘内侧入路的临床应用解剖及其意义

目的:为肘内侧入路手术避免损伤重要结构提供解剖学基础。方法:选教学用的固定尸体标本24具(男18女6)48侧,按手术入路层次,对肘内侧入路的相关血管神经进行解剖学观测。结果:(1)臂内侧皮神经于臂中部的内侧面浅出,直径为(1.05±0.35)mm;前臂内侧皮神经于臂内侧中下1/3肱二头肌内侧沟伴贵要静脉浅出,直径为(1.50±0.55)mm。(2)尺神经干在肘部发出1~3肘关节支、1~4尺侧腕屈肌支和1~4指深屈肌支。(3)尺侧上副动脉、尺侧下副动脉和尺侧返动脉后支从肱动脉的起点处至尺神经垂直距离分别为(1.65±0.35)cm、(2.43±0.54)cm、(1.86±0.41)cm;与尺神经伴行至内上髁的距离分别为(14.38±1.82)cm、(4.51±1.16)cm、(5.91±0.67)cm。肘部附近尺侧下副动脉和尺侧返动脉后支与尺侧上副动脉在尺神经外膜相吻合。结论:(1)肘内侧入路浅层必须寻找和保护臂内侧皮神经和前臂内侧皮神经;(2)肘内侧入路保护尺神经血供及其肌支是临床手术成败的关键。     

肱二头肌腱膜止点变异一例

<正>笔者在一男性左上肢标本肘部操作时,发现该肱二头肌腱膜止点存在变异(图1),该腱膜起于肱二头肌肌腹下端的内侧份,起始处明显有肌丝附着,从形态上观察类似于肱二头肌的另一肌腱。该腱膜平行于肱二头肌肌腱内侧132 mm处走行,其位置较肱二头肌肌腱略浅。止于桡侧腕屈肌上份肌腹,与肱二头肌之间形成类似于"二腹肌"样的结构。腱膜中间宽度7.65mm,厚度0.43mm,其深面有肱动脉和肱静脉穿行,而正中神经未穿其深面。用手触摸该腱膜,其强度较肱二头肌肌腱差。     

异常肌皮神经与正中神经外内侧交通一例

<正>笔者在解剖1具老年男性尸体时发现肌皮神经从臂丛外侧束发出后沿肱二头肌内侧走行,主干先发出细小分支至喙肱肌,然后发出一较大分支,再由其发出细小分支至肱二头肌和肱肌后,延续为前臂外侧皮神经外侧根,最后该肌皮神经在发出一交通支加入正中神经后,终末支发出一细小分支至肱肌后延续为前臂内侧皮神经内侧根。此种变异罕见,现报道如下。肌皮神经从臂丛外侧束发出,起始处横径为5.6 mm,先经     

Topographical anatomy of superficial veins, cutaneous nerves, and arteries at venipuncture sites in the cubital fossa

We investigated correlations among the superficial veins, cutaneous nerves, arteries, and venous valves in 128 cadaveric arms in order to choose safe venipuncture sites in the cubital fossa. The running patterns of the superficial veins were classified into four types (I–IV) and two subtypes (a and b). In types I and II, the median cubital vein (MCV) was connected obliquely between the cephalic and basilic veins in an N-shape, while the median antebrachial vein (MAV) opened into the MCV in type I and into the basilic vein in type II. In type III, the MCV did not exist. In type IV, additional superficial veins above the cephalic and basilic veins were developed around the cubital fossa. In types Ib–IVb, the accessory cephalic vein was developed under the same conditions as seen in types Ia–IVa, respectively. The lateral cutaneous nerve of the forearm descended deeply along the cephalic vein in 124 cases (97 %), while the medial cutaneous nerve of the forearm descended superficially along the basilic vein in 94 (73 %). A superficial brachial artery was found in 27 cases (21 %) and passed deeply under the ulnar side of the MCV. A median superficial antebrachial artery was found in 1 case (1 %), which passed deeply under the ulnar side of the MCV and ran along the MAV. Venous valves were found at 239 points in 28 cases with superficial veins, with a single valve seen at 79 points (33 %) and double valves at 160 points (67 %). At the time of intravenous injection, caution is needed regarding the locations of cutaneous nerves, brachial and superficial brachial arteries, and venous valves. The area ranging from the middle segment of the MCV to the confluence between the MCV and cephalic vein appears to be a relatively safe venipuncture site.     

Superficial venous patterns in the cubital region of Indians

The patterns of the superficial veins of the cubital region were studied in 536 Indian subjects both living and dead. Three basic pattern types were noted. Type I had a median cubital vein joining the cephalic and basilic veins in the cubital region. Type II had the cephalic vein itself draining into the basilic vein in the cubital region. Type III showed the absence of a direct communication between the cephalic and basilic veins in the cubital region. The median vein of the forearm in these latter cases joined either of the cephalic and the basilic veins (type III A) or after bifurcating into a median cephalic and a median basilic vein joined both these veins (type III B). Type I was found to be the most common pattern (67.5%) followed by type II (19.5%), with types III A and III B accounting for 6% and 6.5% of the cases, respectively. Renaming of the median cubital vein as the oblique cubital vein because of its direction and renaming of the median basilic and lateral basilic veins as medial and lateral cubital veins since they follow the medial and lateral borders of cubital fossa respectively has been suggested.     

上臂静脉段移植的应用解剖

目的：为采用自体带瓣臂静脉段移植术治疗下肢深静脉功能不全提供解剖学基础。方法：观测４６侧上臂头静脉、贵要静脉及肱静脉外径、瓣膜的数目和分布。结果：各静脉外径均大于３ｍｍ,但头静脉较贵要静脉和肱静脉细。臂中段的静脉瓣膜比臂上、下段多,所有的臂中段都至少有１条适于带瓣移植的静脉段,而在臂上、下段仅分别为７６％和７０％。结论：在臂中段内侧作切口是截取带瓣贵要静脉或肱静脉段的最适位置。     

头静脉动脉化前臂外侧皮神经移植的解剖学基础及应用

在30侧成人固定上肢上,对头静脉蒂前臂外侧皮神经游离移植进行了有关解剖学观察.前臂外侧皮神经主干在肘横纹处横径为2.2mm,70％在头静脉深面;在前臂中部横径为1.4mm,23％在头静脉深面,77％在头静脉尺侧,距头静脉0.6cm.1987年9月以来,采用头静脉蒂动脉化前臂外侧皮神经游离移植,修复腕部正中、尺神经陈旧性损伤3例,疗效较满意.     

Superficial brachial artery crossing over the ulnar and median nerves from posterior to anterior: Embryological significance

A rare variation of the superficial brachial artery was found in the right arm of an 82-year-old male cadaver in student dissection practice. In this case, the axillary artery passed normally between the medial and lateral roots of the median nerve and then bifurcated into a large superficial brachial artery and the deep brachial artery (A. brachialis profunda). The superficial brachial artery passed medially to the ulnar nerve and then crossed over to take a lateral course to the median nerve at the midpoint of the upper arm. It finally divided into the radial and ulnar arteries at the cubital fossa. The deep brachial artery terminated as the inferior ulnar collateral artery. These findings indicate that the present variant was a well-developed medial type of the superficial brachial artery that gave off the ulnar and radial arteries. The anatomical and embryological significance of the findings are discussed.     

Anatomy of arm veins: Significance for vein valve transplantation

Vein valve transplantation is a recently described operation to treat the sequelae of lower extremity venous hypertension resulting from valvular dysfunction. The operation involves harvesting a segment of an arm vein contianing a competent valve and transplanting it into a lower extremity vein. To determine the optimal incisions for obtaining a suitable valve-containing segment of vein, 20 cadaver arms were dissected. Cephalic, basilic, and brachial veins were examined for size, distribution of valves, and presence of tandem valves (defined as valves separated by 2 cm or less). Because patency rates are low in vascular grafts < 4 mm in diameter, only veins of this size or greater were considered adequate for transplantation. Cephalic veinswere found to have a consistently smaller diameter than basilic or brachial veins (P < 0.0001). Incisions for exposure of the basilic and brachial veins were evaluated. When exposure was limited to the middle third of the arm, an adequate vein, either the basilic or one of the brachial veins, was found in all cases. When either the distal or proximal third of the arm was exposed, however, an adequate vein was found in only 70% of the cases (P < 0.02). Tandem valves, although potentially useful, were present in only 5%, 25%, and 20%, respectively, of distal, middle, and proximal arm segments. Based on the results of this study, a medial incision along the middle third of the arm, exposing a basilic or brachial vein, is recommended as the optimal approach for vein harvesting in vein valve transplantation.     

以前臂内侧皮神经及营养血管为蒂的前臂内侧皮瓣的应用解剖

目的　为带前臂内侧皮神经及其营养血管筋膜皮瓣提供形态学基础。方法　在 32侧成人上肢标本上 ,观测前臂内侧皮神经营养血管及其周围皮肤的血供情况。结果　前臂内侧皮神经近侧的血供来源于尺侧返动脉混合肌皮支 ,起始处外径为 0 .8mm ,穿出深筋膜前长度为 1.1cm ;中部主要来自尺动脉近中段和远中段的粗大皮支 ,起始处外径均为 0 .7mm ,穿出深筋膜前长度均为 1.0cm ;远侧有尺动脉腕上皮支 ,起始处外径为 0 .9mm ,穿出深筋膜前长度均为 1.0cm ;远侧有尺动脉腕上皮支 ,起始处外径为 0 .9mm ,穿出深筋膜前长为 2 .6cm。其神经旁血管网与神经皮穿支及神经内血管广泛吻合组成了皮神经血管轴。结论　可设计成带前臂内侧皮神经及营养血管为蒂筋膜上瓣 ,顺行或逆行转位修复邻近部位的软组织缺损。     

Superficial ulnar artery originating from the brachial artery and its clinical importance

We found a left superficial ulnar artery in the cadaver of a Japanese woman. This anomalous vessel originated from the brachial artery at a site 55 mm distal to the inferior border of the teres major muscle and medial to the median nerve, ran downward and medially superficial to the forearm flexor muscles, and then downward to enter the hand. It formed superficial and deep palmar arches with the radial artery. The clinical importance of the anomalous ulnar artery is discussed.     

以前臂内侧皮神经及营养血管为蒂筋膜皮瓣的应用解剖

目的:为带前臂内侧皮神经及其营养血管筋膜皮瓣提供形态学基础。方法:在32侧成人上肢标本上,观测前臂内侧皮神经营养血管及其周围皮肤的供血情况。结果:前臂内侧皮神经近侧的血供来源于尺侧返动脉混合肌皮支,起始处外径为0.8mm,穿出筋膜前长度为1.1cm;中段主要来自尺动脉近中段和远中段的粗大皮支,起始处外径均为0.7mm,穿出深筋膜前长度均为1.0cm;远侧有尺动脉腕上皮支,起始处外径为0.9mm,穿出深筋膜前长为2.6cm。其神经旁血管网与神经皮(穿)支及神经内血管广泛吻合组成了皮神经血管轴。结论:可设计成带前臂内侧皮神经及营养血管为蒂筋膜皮瓣,顺行或逆行转位修复邻近部位的软组织缺损。