臀大肌肌皮瓣课件

运动解剖学-臀大肌（十三）位置与结构：臀大肌属于髋外肌的一部分，髋外肌这群肌肉主要位于臀部，又称为臀肌，按其位置的深浅分为三层。

浅层目前向后有阔筋膜张肌和臀大肌，中层有臀中肌梨状肌、闭孔内肌和股方肌，深层有臀小肌和闭孔外肌。

位于臀部皮下，大而肥厚，形成特有的臀部隆起为不规则的四方形阔肌，覆盖臀中肌的后部及其他臀肌的全部（阔筋膜张肌除外）。

肌连接：上方至髂骨后面臀后线，骶骨和尾骨的后面，以广泛的短腱起自髂后上棘到尾骨尖之间的部位，有臀后线以后的髂骨背面、骶骨下面和尾骨背面以及两骨之间的韧带，胸腰筋膜和骶结节韧带，肌纤维平行斜外下方至股骨上部。

下方上部大部分移行于髂胫束的深面，下部小部分止于股骨的臀肌粗隆。

功能：髋关节后伸.外旋、外展。

臀大肌是强有力的攀登机，伸展大腿，特别是从屈曲位如爬楼梯或从坐位站起时。

神经支配：臀上神经L3-S1支配。

表现：屁股沟至大腿后面，尾骨不适感，翻身困难，不能久坐'。

二、。

臀大肌无力时身体向后倾斜，常以一手付托臀部帮助行走。

三、走路上坡时不适感，臀部和大腿屈曲受限步伐倾斜。

四、天冷时臀部抽筋。

五、坐位姿态异常，其表现是双膝分开，不能靠拢。

六、臀大肌的劳损一般不会引起臀部的tt，其表现为下腰部、臀外侧、尾骨、臀沟的不适感。

七、如果弯下腰无法触到脚趾，其中有一部分的原因，首先是由于劳损所致的臀大肌挛缩。

八、臀大肌的劳损所引起的不适常被误认为臀部的滑囊y、腰间盘突出z、关节y、坐骨神经或者松弛的骶髂关节所引起的尾骨部的不适，通常误认为尾骨的损s，其实这都是来自附近劳损的关联t。

九、臀大肌是髂腰肌的拮抗肌，在背下部不适时经常涉及到它。

码字不易喜欢加关注，分享更多软组织知识。

岛状臀大肌肌皮瓣在臀部软组织缺损修复中的应用目的:探讨岛状臀大肌肌皮瓣在臀部软组织缺损尤其是骶尾部褥疮修复中的应用。

方法:以臀大肌臀上动脉穿出点为旋转轴,利用臀上动脉和臀下动脉交通支所在的臀大肌外缘肌为蒂,以旋转点至缺损区最近点为肌皮瓣蒂长度,根据缺损部位及大小进行肌皮瓣设计,形成岛状肌皮瓣,肌皮瓣面积稍大于缺损区创面。

蒂部仅含臀大肌外缘肌肉,宽度 1.5～2.0cm。

沿设计线切开皮肤找到臀大肌臀上动脉穿出点及臀大肌外缘,向远端解剖,在臀大肌下形成的岛状皮瓣,通过皮下隧道将肌皮瓣转移到缺损区,逐层缝合切口。

供区视大小可行直接拉拢缝合或邻近皮瓣转移或植皮修复。

结果:应用岛状臀大肌肌皮瓣修复臀部软组织缺损7例,术后肌皮瓣全部成活,被修复处色泽、厚度及外形均满意。

结论:岛状臀大肌肌皮瓣血供丰富,血管恒定,抗感染能力强,切取及转移方便,是修复臀部软组织缺损尤其是骶尾部褥疮的理想肌皮瓣。

Abstract:ObjectiveTo explore the application of island gluteus maximus musculocutaneous flap in repairing the haunch soft tissue defect expecially sacroiliac tissue effect.MethodsThe rotation point was located at superior gluteal artery of gluteus maximus,the flap pedicle included lateral gluteus maximus and communicating branch of superior gluteal artery and inferior gluteal artery. The distance between the rotation point and subterminal borde of the defect was the length of the muscular flap, the island flap was contrived depending on size and location of the defect. The width of flap was slightly larger than the defect. The pedicle only contained outer gluteus maximus muscle, the width of pedicel was 1.5～2cm. The flap was cut down from the starting point ofsuperior gluteal artery in gluteus maximus to the lateral borde of gluteus maximus. The flap was transferred to the defect through the tunnel between the pedicle and defect.The wounds at donor sites were closed directly or with skin graft or local flaps.Results7 cases were treated. All the maximus musculocutaneous flaps survived with good texture,color and thickness.ConclusionsThe island gluteus maximus musculocutaneous flap is an ideal flap for the haunch soft tissue defect expecially sacroiliac tissue effect with reliable blood supply,permanent blood vessel and powerful anti-infection capability. It is easily performed and very practical.Key words:musculocutaneous flap; haunch; reconstructive surgical procedures臀部软组织缺损尤其是骶尾部褥疮的修复方法很多[1-2],应用岛状臀大肌肌皮瓣修复的报道不多见。

臀大肌肌皮瓣的解剖学特点及临床应用张春雷;张建平【期刊名称】《医学综述》【年(卷),期】2011(17)12【摘要】臀大肌是臀肌中最大、最表浅的肌,其滋养血管为臀上动脉和臀下动脉,且有相应的静脉、神经伴行.这一解剖学特点拓展了臀大肌肌皮瓣的临床应用范围,尤其为修复凹陷性缺损创面提供了一种新方法.其修复创面的主要移植方式有:旋转移植;V-Y推进移植;岛状臀大肌肌皮瓣;穿支皮瓣转移.近来在使用臀大肌肌皮瓣进行功能重建方面也较成熟,如重建肛门括约肌和乳房再造.未来在治疗臀肌挛缩症方面将有新突破.%The gluteus maximus is the largest and most superficial gluteal muscle nourished by the superior gluteal artery and the inferior gluteal artery, paralleled with corresponding veins and nerves. The anatomical characteristics enlarges the clinical extent of the gluteal musculocutaneous flap, especially as a new way in repairing cupped wound,major transplant manners including: rotational transplant, V-Y advancement transplant,island gluteal musculocutaneous flap and perforator flap. The functional reconstruction with gluteal musculocutaneous flap of breast and sphincter muscle of anus is becoming matured recently. Breakthrough is also expected in the treatment of gluteal muscle contracture in the future.【总页数】3页(P1821-1823)【作者】张春雷;张建平【作者单位】江苏省沭阳县中医院骨科,江苏,沭阳,223600;江苏省沭阳县中医院骨科,江苏,沭阳,223600【正文语种】中文【中图分类】R622【相关文献】1.负压封闭引流结合臀大肌肌皮瓣治疗骶尾部褥疮的临床应用 [J], 张国烈;温羡宏;冯文参;胡玉霞;谭伟雄2.臀大肌肌皮瓣的基础研究与临床应用 [J], 武勇进;刘立刚3.负压封闭吸引装置联合臀大肌上部肌皮瓣在修复骶尾部Ⅳ期压疮中的临床应用[J], 周文武;申建;沈沛;袁振奋4.臀上动脉浅支臀大肌上部肌皮瓣修复骶尾部褥疮的临床应用 [J], 韦建勋;梁斌5.臀大肌肌皮瓣修复骶尾部褥疮的临床应用 [J], 李春伟;朱定川;高峰因版权原因，仅展示原文概要，查看原文内容请购买。