基于下肢CT血管成像的腘动脉分支变异的解剖学研究

doi:10.3760/cma.j.cn101202-20191030-00327

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摘要目的探讨腘动脉分支变异率及相关解剖学参数。方法回顾性分析2014年6月—2018年12月解放军联勤保障部队第920医院205例(387肢)患者的术前下肢血管CT成像(CTA)资料,其中男153例、女52例,年龄12~79岁;双下肢182例、单侧下肢23例,左侧195肢、右侧192肢。通过Mimics软件三维重建小腿动脉图像,观察腘动脉分支的解剖变异形态,根据Kim-Lippert分型统计腘动脉分支解剖变异Kim Ⅲ型及其各亚型变异率;测量变异分支动脉的相关解剖学参数,包括变异动脉分支起始处外径、分支末端外径、分支动脉长度、分支动脉缺失处至踝关节水平长度等,并与腘动脉正常分支比较。结果 205例患者中有33例(43肢)发生腘动脉分支变异:Kim ⅢA型变异发生率4.1% (16/387肢) ;ⅢB型变异发生率3.4%(13/387肢);ⅢC型变异发生率0.26%(1/387肢);ⅢD型变异发生率1.8%(7/387肢);特殊类型变异5例6肢(6/387,1.6%),主要表现为胫前或胫后动脉未缺失,腓动脉增粗替代形成足背或足底动脉。28例(37肢)腘动脉分支KimⅢ型解剖变异于小腿中下1/3处发生缺失,变异的主干动脉分支均为不完全缺失,胫后动脉(ⅢA型)、胫前动脉(ⅢB型)、腓动脉(ⅢA型)变异分支长度分别为(176.8±51.2)、(187.9±73.7)、(153.4±58.5)mm;其管径(起始处外径、分支末端外径)均较正常腘动脉分支细,差异均有统计学意义(P值均＜0.01)。结论腘动脉分支存在广泛的解剖变异模式,其总变异率为11.1%,术前通过下肢CTA可准确判断腘动脉分支解剖形态,为降低临床下肢手术的风险提供解剖学依据。

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	许育健
	何晓清
	徐永清
	叶洪
	罗浩天
	杨曦
	张旭林
	赵万秋

关键词 ：腘动脉, 遗传变异, 血管造影术, 成像,三维,计算机辅助, 临床解剖学

Abstract：Objective To study the variation rate and related anatomical parameters of popliteal artery branches based on CT angiography (CTA) of the lower extremity.Methods The lower-extremity CTA data of 205 patients (387 limbs) obtained before operation at the 920th Hospital of the Joint Service Support Force of the People's Liberation Army from June 2014 to December 2018 were analyzed retrospectively. The study population included 153 males, 52 females, aged 12-79 years, 182 lower limbs, 23 unilateral limbs, 195 left limbs, and 192 right limbs. All of the data were analyzed by Mimics software, and 3D reconstruction of the leg artery was carried out. The anatomical variation of the popliteal artery branches was observed, and statistics of the variation rate of popliteal artery branches of the Kim Ⅲ type and its subtypes according to the Kim-Lippert classification were recorded. Measurement and comparison of the anatomical parameters of the popliteal artery normal branches, as well as the variation of these branches, including the outer diameter of the starting point, the outer diameter of the branch end, the length of the branch artery, the loss of the branch artery to the ankle joint, and horizontal length, among others, were also carried out.Results Among 205 patients, 33 (43 limbs) had popliteal artery branch variations. The variation rate of type ⅢA popliteal artery branches was 4.1% (16/387), that of type ⅢB popliteal artery branches was 3.4% (13/387), that of type ⅢC popliteal artery branches was 0.26% (1/387), and that of type ⅢD popliteal artery branches was 1.8% (7/387). Five patients (6 limbs) (6/387, 1.55%) showed unique types of variations. These variations mainly manifested as the absence of anterior or posterior tibial arteries and thickening of the peroneal artery replacing the formation of the dorsalis or plantar arteries. Twenty eight cases with Kim Ⅲ anatomical variations showed popliteal artery branches missing in the middle and lower 1/3 of the leg and the main artery branches were incomplete. The lengths of the variant branches of the posterior tibial artery (type ⅢA), anterior tibial artery (type ⅢB), and peroneal artery (type ⅢA) were (176.8±51.2) mm, (187.9±73.7) mm, and (153.4±58.5) mm, respectively. The diameter of the popliteal artery was smaller than that of the popliteal artery (all P values<0.01).Conclusions The total variation rate of popliteal artery branches is 11.1%. The anatomy of popliteal artery branches can be accurately judged by CTA before operation to provide an anatomical basis for reducing the risk of clinical lower limb operation.

Key words： Popliteal artery Genetic variation Angiography Imaging, three-dimensional, computer assisted Clinical anatomy

收稿日期: 2019-10-30

通讯作者: 何晓清,Email:hxq00@foxmail.com

引用本文:

许育健, 何晓清, 徐永清, 叶洪, 罗浩天, 杨曦, 张旭林, 赵万秋. 基于下肢CT血管成像的腘动脉分支变异的解剖学研究[J]. 中华解剖与临床杂志, 2020, 25(5): 472-477.
Xu Yujian, He Xiaoqing,Xu Yongqing, Ye Hong, Luo Haotian, Yang Xi, Zhang Xulin, Zhao Wanqiu. Anatomical study of popliteal artery branch variation based on CT angiography of the lower extremity. Chinese Journal of Anatomy and Clinics, 2020, 25(5): 472-477.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20191030-00327 或 http://www.cjac.com.cn/CN/Y2020/V25/I5/472

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