带血管蒂髌骨移位修复膝关节面缺损的应用解剖

Applied anatomy of vascular pedicle patella translocation for repairing knee joint surface defect

目的 :研究用带血管蒂髌骨移位的方法修复股骨髁和胫骨髁关节面缺损。方法 :用 37侧经动脉红色乳胶灌注的下肢标本 ,经解剖、厚切片和铸型研究髌骨的血供。观测 30块髌骨和胫骨内外侧髁关节面的形态和面积。结果 :供应髌骨的各支动脉先在髌骨周围吻合成髌周动脉环 ,再由该环发支进入髌骨 ;参与形成髌周动脉环的主要动脉有膝上外动脉、膝下外动脉、膝降动脉髌上支、膝降动脉髌下支和膝下内动脉 ;髌骨关节面与股骨内外侧髁下关节面、胫骨内外侧形态大小相似。结论 :带血管蒂髌骨可以移位至股骨内外侧髁、或胫骨内外侧髁 ,利用髌骨的关节面修复股骨髁或胫骨髁关节面缺损 ,以期最大限度地保留膝关节的功能。

Objective: To find a way of repairing the knee joint surface defect with the vascular pedicle patella translocation. Methods: The patella blood supply was studied by dissection, thick section and cast on 37 adult lower limbs that were perfused by the red emulsion. The morphology and area of 30 patellae and tibiae (internal or external condyles) were observed and evaluated. Results: The arteries supplying the patella formed a ring round patella, then the ring sent smaller branches into the bone. The lateral superior genicular artery, the lateral inferior genicular artery, the superior patella branch and inferior patella branch of the descending genicular artery and the medial inferior genicular artery constituted the ring. The articular surface of patella was similar to the inferior joint surface of femoral medial and lateral condyles, as well as the superior surface of tibial medial or lateral condyles in shape and area. Conclusion: Vascular pedicle patella can be transposed to medial or lateral condyles of tibia and femur. The method can be used for repairing of knee joint surface defect in order to reserve the knee function to a great extent. [