基于数字化技术的豌豆骨血供及带蒂移位治疗月骨缺血性坏死可行性的解剖研究  

Anatomy of pisiform blood supply and feasibility of vascularized pisiform transfer for avascular necrosis of lunate based on digital technique

作　　者：许育健 徐永清[2] 罗浩天 何晓清 张旭林 赵万秋 吴欢 袁礼波 XU Yujian;XU Yongqing;LUO Haotian;HE Xiaoqing;ZHANG Xulin;ZHAO Wanqiu;WU Huan;YUAN Libo(The Graduate School,Army Military Medical University,Chongqing,400000,P.R.China;Department of Orthopeadics,the 920th Hospital of Joint Logistics Support Force,Kunming Yunnan,650032,P.R.China)

机构地区：[1]陆军军医大学研究生院,重庆400000 [2]中国人民解放军联勤保障部队第920医院骨科,昆明650032

出　　处：《中国修复重建外科杂志》2020年第5期596-601,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的采用数字化技术对豌豆骨及其血供进行解剖观测,为临床带蒂豌豆骨移位治疗晚期月骨缺血性坏死(Kienb?ck病)提供解剖学依据。方法取12具成人新鲜腕关节标本,从尺动脉或桡动脉灌注明胶-氧化铅溶液后,行Micro-CT扫描并采用Mimics软件三维重建图像。观察豌豆骨及月骨形态,测量二者纵径、横径及厚度;观察豌豆骨周围血供,其近端、远端、桡侧及尺侧滋养孔分布情况,记录滋养孔数量、直径;测量豌豆骨移位时可选择的血管蒂(尺动脉干分支、腕上皮支、腕上皮支降支和掌深支返支)相关解剖参数,包括血管蒂起始处外径及血管蒂至豌豆骨、月骨距离。结果三维测量显示豌豆骨厚度与月骨差异无统计学意义(t=1.269,P=0.109),纵径与横径均明显小于月骨(t=6.653,P=0.000;t=6.265,P=0.000)。豌豆骨尺、桡侧和远、近端表面均有滋养血管。其中,豌豆骨近端滋养孔数量明显多于远端(P<0.05),但近端、远端、桡侧和尺侧滋养孔直径比较,差异均无统计学意义(P>0.05)。掌深支返支血管蒂起始处外径明显小于腕上皮支、腕上皮支降支(P<0.05);其余血管蒂间比较,差异均无统计学意义(P>0.05)。血管蒂至豌豆骨、月骨距离除尺动脉干分支与掌深支返支比较、腕上皮支与腕上皮支降支比较,差异无统计学意义(P>0.05);其余组间差异均有统计学意义(P<0.05)。结论豌豆骨近端及尺侧滋养血管丰富,因此带蒂豌豆骨移位术中游离豌豆骨时应尽量避免过多剥离近端和尺侧软组织;宜选择带尺动脉腕上皮支及其降支蒂的豌豆骨移位治疗晚期Kienb?ck病。Objective To provide anatomical basis for vascularized pisiform transfer in the treatment of advanced avascular necrosis of the lunate(Kienb?ck’s disease)by studying its morphology and blood supply pattern based on digital technique.Methods Twelve adult fresh wrist joint specimens were selected and treated with gelatin-lead oxide solution from ulnar or radial artery.Then the three-dimensional(3D)images of the pisiform and lunate were reconstructed by micro-CT scanning and Mimics software.The morphologies of pisiform and lunate were observed and the longitudinal diameter,transverse diameter,and thickness of pisiform and lunate were measured.The main blood supply sources of pisiform were observed.The number,diameter,and distribution of nutrient foramina at proximal,distal,radial,and ulnar sides of pisiform were recorded.The anatomic parameters of the pedicles(branch of trunk of ulnar artery,carpal epithelial branch,descending branch of carpal epithelial branch,recurrent branch of deep palmar branch)were measured,including the outer diameter of pedicle initiation,distance of pedicle from pisiform,and distance of pedicle from lunate.Results There were significant differences in the longitudinal and transverse diameters between pisiform and lunate(t=6.653,P=0.000;t=6.265,P=0.000),but there was no significant difference in thickness(t=1.269,P=0.109).The distal,proximal,radial,and ulnar sides of pisiform had nutrient vessels.The nutrient foramina at proximal side were significantly more than that at distal side(P<0.05),but there was no significant difference in the diameter of nutrient foramina between different sides(P>0.05).The outer diameter of pedicle initiation of the recurrent branch of deep palmar branch was significantly smaller than the carpal epithelial branch and descending branch of carpal epithelial branch(P<0.05).There was no significant difference in the distance of pedicle from pisiform/lunate between branch of trunk of ulnar artery and recurrent branch of deep palmar branch(P>0.05),and between carpal

关 键 词：月骨缺血性坏死 Kienböck病 豌豆骨 带蒂骨移位术 解剖研究 

分 类 号：R687.3[医药卫生—骨科学]