Morphological study on the transverse branch of lateral femoral circumflex artery based on digital subtraction angiography
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摘要:
目的 结合数字减影血管造影（DSA）技术总结旋股外侧动脉横支的形态学特点并探讨其临床意义。 方法 采用回顾性观察性研究方法。2020年10月—2021年5月，苏州瑞华骨科医院收治62例符合入选标准的四肢软组织损伤患者，其中男40例、女22例，年龄20~72岁。对患者行股前外侧皮瓣移植术前股外侧区的DSA，结合显影标尺观测血管大体情况以及旋股外侧动脉横支的出现情况（计算出现率）、源动脉、发出点位置、走行方向与皮穿支穿出点位置，另进行横支形态学特点分类。 结果 DSA检查显示，62例患者股动脉、股深动脉及旋股外侧动脉各分支均清晰可辨。在59例患者中观察到旋股外侧动脉横支，其中52例为单横支、7例为双横支，横支的出现率为95.2%（59/62）。共观察到66条旋股外侧动脉横支，其中3条发自股深动脉、63条发自旋股外侧动脉；横支发出点距髂前上棘6.5~12.7 cm；横支约与身体长轴垂直向外侧发出，在旋股外侧动脉升支与旋股外侧动脉斜支之间走行，沿途发出分支，主干走行至大转子下方；横支皮穿支穿出点距髂前上棘8.0~18.0 cm。旋股外侧动脉横支形态学特点分类中，以与1条旋股外侧动脉其他分支共干发出者最为常见，占50.0%（31/62）；其次为自旋股外侧动脉（12例）或股深动脉（3例）单干发出者，占24.2%（15/62）；特殊类型者占21.0%（13/62），包括双横支者7例、与多条旋股外侧动脉其他分支共干者6例；横支细小/缺如者仅占4.8%（3/62）。在前述双支共干关系中，以横支与升支共干者最为常见，占77.4%（24/31）；横支与斜支共干者（5例）、横支与降支共干者（2例）共占22.6%（7/31）。 结论 通过DSA观察到旋股外侧动脉横支出现率高，该横支多自旋股外侧动脉约与身体长轴垂直向外侧发出，以与另一条旋股外侧动脉主要分支，尤其是升支共干发出为主，该定位分析可为股前外侧皮瓣设计与切取提供重要参考。 -
关键词:
- 血管造影术，数字减影 /
- 显微外科手术 /
- 外科皮瓣 /
- 旋股外侧动脉横支
Abstract:Objective To summarize the morphological characteristics of the transverse branch of lateral femoral circumflex artery (LFCA) using digital subtraction angiography (DSA) and explore its clinical significance. Methods A retrospective observational study was conducted. From October 2020 to May 2021, 62 patients with soft tissue injuries in the extremities were hospitalized in Suzhou Ruihua Orthopedic Hospital, including 40 males and 22 females, aged from 20 to 72 years. DSA was performed in the lateral femoral region of patients before the anterolateral thigh flap transplantation, and in combination with imaging scale to observe and measure the general condition of the blood vessels and the occurrence (with the occurrence rate being calculated), source artery, location of the origin point, direction of course, and the location of the perforating point of the cutaneous perforator of the transverse branch of LFCA, and in addition to classify the morphological characteristics of the transverse branch. Results DSA detection showed that the femoral artery, the deep femoral artery, and the branches of LFCA were clearly distinguishable in 62 patients. Transverse branches of LFCA were observed in 59 patients, including 52 cases with a single transverse branch, and 7 cases with double transverse branches. The occurrence rate of transverse branches was 95.2% (59/62). A total of 66 transverse branches of LFCA were observed, of which 3 originated from the deep femoral artery, and 63 originated from the LFCA. The origin point of the transverse branch was 6.5-12.7 cm away from the anterior superior iliac spine. The transverse branch which was approximately perpendicular to the long axis of the body, originated outwards, ran between the ascending branch of LFCA and the oblique branch of LFCA, and branched along the way, with the trunk running under the greater trochanter. The perforating point of the cutaneous perforator of the transverse branch was 8.0-18.0 cm away from the anterior superior iliac spine. In the classification of morphological characteristics of the transverse branch of LFCA, the most common type was the one that originated from the same trunk with other branches of LFCA, accounting for 50.0% (31/62), followed by the one that originated from the singular trunk of LFCA (12 cases) or deep femoral artery (3 cases), accounting for 24.2% (15/62); the special type accounted for 21.0% (13/62), including 7 cases of double transverse branches and 6 cases of the transverse branch originated from the same trunk with multiple other branches of LFCA; those with small/absent transverse branch only accounted for 4.8% (3/62). Among the above-mentioned common trunk relationship of two branches, those with shared trunk of ascending and transverse branches were most frequently observed, accounting for 77.4% (24/31); those with shared trunks of the transverse and oblique branches (5 cases) and the transverse and descending branches (2 cases) accounted for 22.6% (7/31) altogether. Conclusions A high incidence rate of the transverse branch of LFCA is observed through DSA. The transverse branch originates from the lateral femoral artery approximately perpendicular to the long axis of the body, mainly from the same trunk with another main branch of LFCA, especially the ascending branch. This positioning analysis can provide an important reference for the design and resection of anterolateral femoral flaps. -
参考文献
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