Hootnick D R, Packard D S, Levinsohn E M, Lebowitz M R, Lubicky J P
Teratology. 1984 Apr;29(2):155-64. doi: 10.1002/tera.1420290202.
Previous studies have shown an association between an abnormal arterial pattern and bony malformations of the human lower limb. We have dissected and performed arteriography on a congenitally short limb with ectrodactyly in order to examine the relationship between arterial pattern and bony anomalies in another type of deformity. The bony anomalies were a combination of short femur, tibia and fibula, clubfoot with tarsal synostoses, metatarsal absence, ectrodactyly, and a bifid hallux. The arterial pattern was characterized by deficiency of the anterior tibial artery and absence of the plantar arch. Major muscular anomalies were noted in the foot only; the muscles of the missing toe were absent and any muscles that normally cross the midventral line were either missing or failed to cross the midline. The superficial peroneal nerve failed to enter the dorsum of the foot and its sensory distribution was assumed by an extra branch of the sural nerve. The most severe abnormalities of the bones, muscles, arteries, and nerves occurred near the midventral line of the foot. We hypothesize that the abnormal arterial pattern put the limb at risk of teratogenic damage by reducing the number of collateral blood supply routes. We suggest that some event, such as extravasation of blood or embolization, compromised the blood flow in the remaining blood vessels and that this event resulted in both a general shortening of the limb and the specific defects observed in the foot. We interpret the anatomy to be consistent with the vascular teratogenic event occurring near the midline of the foot during the fifth week of embryonic development.
先前的研究表明，异常的动脉模式与人类下肢的骨畸形之间存在关联。我们对一例患有先天性短肢并伴有缺指（趾）畸形的病例进行了解剖和动脉造影，以研究另一种畸形类型中动脉模式与骨异常之间的关系。骨异常包括股骨、胫骨和腓骨短小，伴有跗骨融合的马蹄内翻足，跖骨缺如，缺指（趾）畸形，以及拇趾裂。动脉模式的特征是胫前动脉缺如和足底弓缺失。主要的肌肉异常仅见于足部；缺失趾的肌肉缺如，任何正常穿过腹中线的肌肉要么缺如，要么未能穿过中线。腓浅神经未能进入足背，其感觉分布由腓肠神经的一个额外分支承担。骨骼、肌肉、动脉和神经的最严重异常发生在足的腹中线附近。我们推测，异常的动脉模式通过减少侧支血液供应途径的数量，使肢体处于致畸损伤的风险中。我们认为，诸如血液外渗或栓塞等事件损害了其余血管的血流，并且这一事件导致了肢体的普遍缩短以及足部观察到的特定缺陷。我们认为这种解剖结构与胚胎发育第五周时在足中线附近发生的血管致畸事件是一致的。
