对大多角骨和小多角骨带血运骨瓣或复合组织瓣的解剖学观察  

Anatomical study of the vascularized trapezium and trapezoid bone flaps or compound tissue flap

作　　者：肖滋润 陈佳 卫阔 江小萌 杨涛 朱光显 幸超峰 Xiao Zirun;Chen Jia;Wei Kuo;Jiang Xiaomeng;Yang Tao;Zhu Guangxian;Xing Chaofeng(Department of Orthopedics,the PLA Joint Logistics Support Force No.988 Hospital,Zhengzhou 450042,China)

机构地区：[1]中国人民解放军联勤保障部队第九八八医院骨科,郑州450042

出　　处：《骨科临床与研究杂志》2025年第2期104-108,共5页Journal Of Clinical Orthopedics And Research

基　　金：河南省医学科技计划项目(联合共建项目LHGJ20210805)。

摘　　要：目的探讨大多角骨、小多角骨作为潜在骨瓣或骨-韧带-骨复合组织瓣移植供区的可能性。方法对来自6例遗体捐献者的12例成人上肢福尔马林固定后标本大多角骨、小多角骨血供来源及滋养动脉走行进行解剖观察。将10个标本的大多角骨、小多角骨完整切取后使用MicroCT扫描,再用Mimics Medical软件重建形成骨的三维模型,测量并评估可截骨骨量。对2例标本进行模拟手术操作,其中1侧切取以大多角骨背侧滋养动脉或桡动脉为蒂的大多角骨背外侧骨瓣;另1侧切取以桡动脉为蒂的大多角骨-背侧韧带-小多角骨复合组织瓣,评估这2种方式重建舟骨、月骨血供的潜力。结果大多角骨、小多角骨的血供均主要来自于桡动脉,血供丰富可靠。大多角骨背外侧骨瓣可截取骨量较大,可以用于修复舟骨及月骨损伤,但其滋养动脉较短,可能需要切断桡动脉作为血管蒂或者采用游离骨瓣的方式。大多角骨-背侧韧带-小多角骨的复合组织瓣可用于修复舟月韧带损伤,可截取骨量较大且符合舟月关节解剖关系者,但带血运移植必须以桡动脉为血管蒂。结论大多角骨、小多角骨可以作为修复腕舟骨、月骨损伤的潜在供区,但可能需选择游离移植或者以桡动脉作为血管蒂。Objective To explore the potential of the trapezium and trapezoid as donor sites for bone flaps or bone-ligament-bone compound tissue flaps.Methods An anatomical study was conducted on 12 adult upper limb specimens fixed in formalin from 6 cadaver donors,observing the blood supply sources and the path of the nourishing arteries for the trapezium and trapezoid.Ten specimens were completely excised for MicroCT scanning,and three-dimensional models of the bone were reconstructed using Mimics Medical software to measure and evaluate the available bone volume for osteotomy.Simulated surgical procedures were performed on 2 specimens:one conducted the trapezium dorsal-lateral flap pedicled with the nourishing artery on the dorsal aspect or the radial artery,while the other one conducted the trapezium-dorsal ligament-trapezoid bone compound tissue flap pedicled with the radial artery to evaluate the potential of these two methods in reconstructing the blood supply to the scaphoid and lunate bones.Results The blood supply to both the trapezium and trapezoid primarily originated from the radial artery,demonstrating rich and reliable blood supply.The trapezium dorsal-lateral flap could provide a substantial amount of bone for the repair of scaphoid and lunate injuries;however,the nourishing artery was relatively short,which needed the radial artery as vascular pedicle or free flap technique.The trapezium-dorsal ligament-trapezoid bone compound tissue flap could be utilized for repairing scapholunate ligament injuries,which conformed to the anatomical relationships of the scapholunate joint and had enough bone for osteotomy,but vascularized transfer must utilize the radial artery as the pedicle.Conclusion The trapezium and trapezoid can serve as potential donor sites for the repair of scaphoid and lunate injuries,although free flap transfer or vascular pedicled flap with radial artery may be necessary.

关 键 词：大多角骨 小多角骨 尸体解剖 带血运骨瓣 骨-韧带-骨复合组织瓣 

分 类 号：R683.41[医药卫生—骨科学]