上海口腔医学

上海口腔医学 ›› 2023, Vol. 32 ›› Issue (6): 603-608.doi: 10.19439/j.sjos.2023.06.008

• 论著 • 上一篇    下一篇

血管化髂骨肌瓣的应用解剖学特点及其在颌骨缺损修复中的临床应用

张扬1,2, 祝庆海1, 张永杰3, 王晨星1,*, 叶金海1,4,*   

  1. 1.江苏省口腔疾病研究重点实验室,南京医科大学附属口腔医院 口腔颌面外科,江苏 南京 210029;
    2.徐州医科大学附属市立医院 口腔科,江苏 徐州 221116;
    3.南京医科大学基础医学院解剖教研室,江苏 南京 211166;
    4.复旦大学附属中山医院 口腔颌面外科,上海 200032
  • 收稿日期:2023-09-15 修回日期:2023-10-20 出版日期:2023-12-25 发布日期:2024-01-12
  • 通讯作者: 王晨星,E-mail: doctorwcx@njmu.edu.cn;叶金海,E-mail: yejinhai@njmu.edu.cn。*共同通信作者
  • 作者简介:张扬（1982-）,男,硕士研究生,E-mail: zhyzhbj@163.com
  • 基金资助:
    国家自然科学基金(81371123); 江苏高校优势学科建设工程资助项目(2018-87); “科教强卫工程”医学重点人才项目(ZDRCA2016087)

Applied anatomical characteristics of vascularized iliac muscle flap and its clinical application in repairing oral and maxillofacial defects

ZHANG Yang1,2, ZHU Qing-hai1, ZHANG Yong-jie3, WANG Chen-xing1, YE Jin-hai1,4   

  1. 1. Jiangsu Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Nanjing Medical University. Nanjing 210029, Jiangsu Province;
    2. Department of Stomatology, Affiliated Municipal Hospital of Xuzhou Medical University. Xuzhou 221116, Jiangsu Province;
    3. Department of Human Anatomy, Nanjing Medical University. Nanjing 211166, Jiangsu Province;
    4. Department of Oral and Maxillofacial Surgery, Zhongshan Hospital, Fudan University. Shanghai 200032, China
  • Received:2023-09-15 Revised:2023-10-20 Online:2023-12-25 Published:2024-01-12

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摘要： 目的: 通过髂腹股沟区血管及穿支的解剖学及影像学研究,探讨旋髂深动脉（deep circumflex iliac artery,DCIA）来源的髂骨（肌）穿支嵌合皮瓣的可行性及安全性,为不同复合组织缺损的皮瓣修复方案提供应用解剖学和影像学依据。方法: 选取6例12侧中国成人标本,采用双侧股动脉逆行灌注红色乳胶后进行解剖学研究,分析DCIA及其穿支在髂腹股沟区各个层面的分布、走行、长度、管径等特征;同时对12例下肢CTA进行DCIA血管蒂长度、管径、主要分支位置等进行测量,并与解剖学数据进行比较。对2020年8月—2021年11月在南京医科大学附属口腔医院口腔颌面外科就诊的6例下颌骨肿瘤患者,行下颌骨节段性切除术,同期髂骨肌筋膜瓣修复重建,观察患者受区术后外形、咬合功能重建,供区外观和功能恢复情况。采用SPSS 19.0软件包对数据进行统计学分析。结果: 6例12侧人体标本髂腹股沟区解剖发现穿腹部浅筋膜层外径>0.5 mm的DCIA穿支共19条,穿支血管分布在髂前上棘后方5 cm,且位于髂嵴内侧5 cm（长）×3 cm（宽）的区域内。DCIA血管蒂长度为（6.73±1.06） cm,血管蒂起始位置外径测量值为（2.55±0.29） mm,DCIA皮穿支穿深筋膜处外径为（1.12±0.14） mm。在12例下肢CTA分析中发现,DCIA血管蒂长度为（6.98±0.62） cm,血管蒂起始位置管径测量值为（2.35±0.20） mm。6例采用髂骨腹内斜肌筋膜嵌合瓣修复下颌骨缺损的患者,髂骨肌瓣均顺利存活。术后随访6~24个月（平均12个月）,下颌外形、功能恢复良好,口内肌筋膜瓣黏膜化。术后CT发现植入髂骨无明显体积改变,供区行走、负重基本正常,未出现腹疝等并发症。结论: DCIA及主要分支在髂腹股沟区走行、分布较恒定,可根据不同缺损区情况,制备基于DCIA的不同组织类型嵌合皮瓣以满足修复要求。供区未见明显并发症,是下颌骨缺损修复重建较为理想的选择。

关键词: 血管化髂骨瓣, 旋髂深动脉, 应用解剖, 颌骨缺损修复

Abstract: PURPOSE: To investigate the feasibility and safety of the deep circumflex iliac artery (DCIA) derived chimeric flap through the anatomical study of the blood vessels and perforating branches in the ilioinguinal region, and to provide the basis for selecting different DCIA chimeric flap schemes according to the difficulty of surgery, defect conditions and repair needs. METHODS: Six Chinese adult specimens were dissected by retrograde perfusion of red latex into bilateral femoral arteries. At the same time, the length, diameter and main branch position of DCIA vascular pedicle were measured in 12 lower limb CTAs, and compared with the anatomical data. Six patients with oral tumors accompanied by mandibular defects who were treated in the Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University from July 2020 to November 2021 were repaired and reconstructed with the chimeric iliac myofascial flap. The postoperative appearance and occlusal function of the recipient area were observed. SPSS 19.0 software package was used for data analysis. RESULTS: A total of 19 DCIA perforators with an external diameter of ≥ 0.5 mm were found in 12 specimens of ilioinguinal region. These perforators were distributed in the 5 cm×3 cm area, inside the ilium and 5cm behind the anterior superior iliac spine. The length of DCIA vascular pedicle was (6.73±1.06) cm. The measured value of the external diameter of the starting position of the vascular pedicle was (2.55±0.29) mm. The outer diameter of DCIA skin perforator penetrating deep fascia was (1.12±0.14) mm. In the CTA analysis of 12 lower limbs, it was found that the length of DCIA vascular pedicle was (6.98±0.62) cm. The measured diameter at the original position of vascular pedicle was (2.35±0.20) mm. Six cases of mandibular defects were repaired with iliac internal oblique fascia mosaic flap. Six cases of lliac flap survived successfully after operation. Follow up for 6 to 24 months (average 12 months) showed that the mandibular shape and function recovered well, the intraoral myofascial flap became mucosal, and the implanted iliac bone showed no significant volume change on CT after operation. Walking and weight bearing in donor area were basically normal, and no abdominal hernia occurred. CONCLUSIONS: DCIA and its main branches have a relatively constant course and distribution in the ilioinguinal region. According to the conditions of different defect areas, different tissue types of chimeric flaps based on DCIA can be prepared to meet the repair requirements. The donor site complications can be controlled, and it is an ideal choice to repair mandibular defects.

Key words: Vascularized iliac flap, Deep circumflex iliac artery, Applied anatomy, Repair of jaw defects

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