带掌侧血管蒂部分头状骨移位替代坏死月骨的解剖学研究

Anatomical study of volar pedicled capitate transposition for treatment of avascular lunate necrosis

目的观察头状骨的血供分布特点，为带掌侧血管蒂部分头状骨移位替代坏死月骨的手术提供解剖学依据。方法观察100块头状骨标本，将头状骨分成远近两部分，记录各部分掌、背侧滋养血管孔的数量，测量血管孔大小，对所测数据进行统计学分析。制作保留骨和骨外周血管的上肢铸型标本2侧，观察头状骨主要滋养血管的管径、数量和位置；制作上肢的血管灌注标本2侧，解剖头状骨掌侧滋养血管。观察显示骨内滋养血管的头状骨标本5侧。结果100块头状骨标本，掌背侧、掌侧远近端均有丰富的滋养血管孔，背侧滋养血管孔数量略多于掌侧。掌、背侧血管孔径大小方面，掌侧血管孔径大于背侧血管孔（P〈0．01），差异有统计学意义。局部上肢铸型标本和血管灌注标本显示与头状骨标本血管孔的分布和数量相符。结论头状骨远近端均有丰富的滋养血管孔，掌侧滋养血管孔分布管径上优于背侧。表明保留掌侧血管蒂的头状骨近端部分转移替代坏死月骨是有其解剖学基础的，为月骨坏死提供了一种新的手术尝试依据。

Objective To provide the anatomical basis of transferring volar pedicled partial capitate bone to replace lunate bone with necrosis. Methods The distribution characteristics of nutrient arteries of 100 capitates were observed. These capitates were divided into two parts, distal and proximal, to record the quantity and position and measure the caliber of the nutrient arteries. Statistic analyze of the data was conducted. Two casting specimens with bone and peripheral vascular retention were prepared. The caliber, quantity and position of major nutrient arteries of the capitate bone were recorded and measured. Two epipodite specimens with arterial injections of rubber latex were prepared to dissect the dorsal nutrient arteries. Intmcsseons blood vessels of the capitate were observed in 5 specimens on coronal plane sections. Results Both the volar and dorsal aspects of the proximal and distal parts of the capitate were rich of nutrient vessel entries, with the number of vessel entry slightly higher on the dorsal aspect. The caliber size of the volar vasculature of the capitate specimens was significantly bigger than that of the dorsal side （ P 〈 0.01）. The casting specimens and latex perfilsion specimens conformed to the distribution and quantity of nutrient arteries of the capitate. Conclusion Both the distal and proximal portions of the capitate bone are rich of nutrient arteries. Vascular caliber is bigger on the volar side than on the dorsal side. It is anatomically proved that volar pedicled proximal capitate bone flap transfer is suitable to replace lunate bone with necrosis. It is a new surgical model for treating Kienbock disease.