膝关节血供三维可视化研究及其临床意义

Three-dimensional visualizational investigation for blood supply of human knee joint and its clinical significance

目的了解膝关节血管分布和血供模式,为微创化全膝关节置换术入路的选择提供应用解剖学基础。方法1例新鲜成人下肢标本动脉血管改良显影剂灌注后,薄层CT扫描,Mimics10.0软件重建下肢骨与血管;对标本解剖观测。分析膝关节局部血管走行及分布特点,了解各知名血管与全膝关节置换手术入路的关系。结果血管显影清晰,伪影少。重建了膝关节的骨性结构和血管的三维(3D)模型。股动脉、动脉、胫前动脉和股深动脉等血管的分支在膝部交通、吻合,形成可分为髌网、股骨外侧髁和内侧髁网、髌下网等的膝关节血管网。膝关节置换术,经股肌下/经股肌入路时肌肉关节支是防止神经、股动脉损伤的安全标志,应尽可能保留;膝下外侧动脉应注意保护。结论结合CT/MRI、计算机图像处理、3D重建技术,可以直观立体再现膝关节结构及其血供特点,为临床手术入路选择提供直观的参考。

Objective To explore the blood supply of knee joint and to provide anatomic basis for approach selection of minimal invasive total knee replacement. Methods CT data was harvested by CT scanning using 1 adult knee joint specimen which the artery was perfused by contrast medium. The bone and artery structures of knee were 3 D reconstructed using Mimics 10. 01. The method and its effect of transparence demonstration were carried out using Mimics and 3ds max methods separately. Results The artery was distinct with parum constructed defect. The three-dimentional（3D） virtual model of knee joint with bone and arteries was reconstructed. Branches of femoral artery and popliteal artery and anterior tibial artery, also of deep femoral artery formed blood vessel strainer. As a the safe marker for femoral artery in total knee arthroplasty, the musculoarticular branch should be preserved wherever possible if the subvastus approach was used. The lateral inferior genicular artery should be preserved wherever possible too. Conclusions Combining the image technology such as CT, MRI with computer image processing and 3D reconstruction and registration technologies, the direct-viewing bone and arteries of knee joint could be achieved to benefit surgery approach choice.