自体髂骨嵴移位重建掌骨头的解剖学研究

Anatomical study on the reconstruction of the metacarpal bone with autogenous iliac crest grafting

目的 :探讨髂骨嵴与掌骨头相似性,为髂骨嵴移位重建手部掌骨头提供解剖学基础。方法 :16侧上肢标本,10例骨盆标本,解剖观察第2、3、4、5掌骨头及髂骨嵴形态结构特点,测量掌骨头弧高、关节面弧长、掌背径、尺桡径和髂骨嵴弧高、弧长、内外径。将所得到的数据进行统计分析,比较各掌骨头与髂骨嵴在形态、结构特点、弧长及各径线长度相似度。结果:第2掌骨头弧长22.040(21.425,23.085)mm,掌背径(14.034±0.465)mm,弧高4.185(4.113,4.598)mm,尺桡径(12.227±0.414)mm。第3掌骨头弧长23.430(22.743,24.153)mm,掌背径(14.316±0.430)mm,弧高4.235(4.170,4.670)mm,尺桡径(12.382±0.425)mm。第4掌骨头弧长21.960(21.245,22.285)mm,掌背径(12.382±0.288)mm,弧高4.125(4.030,4.305)mm,尺桡径(11.991±0.362)mm。第5掌骨头弧长20.030(19.668,20.148)mm,掌背径(11.807±0.358)mm,弧高4.015(3.880,4.205)mm,尺桡径(11.659±0.399)mm。髂骨嵴弧长(22.930±0.701)mm,内外径14.350(13.660,14.739)mm,弧高(4.520±0.184)mm。髂骨嵴内外径与第2掌骨头掌背径差异无统计学意义(Z=-1.242,P>0.05),髂骨嵴内外径与第3掌骨头掌背径差异有统计学意义(Z=-2.835,P<0.05),髂骨嵴内外径与第4、5掌骨头掌背径差异有统计学意义(Z值分别为-5.094、-5.095,P<0.05);髂骨嵴弧长与第2、4、5掌骨头弧长差异均有统计学意义(t值分别为1.190、-4.909、-13.791,P<0.05),髂骨嵴弧长与第3掌骨头弧长差异无统计学意义(Z=-1.704,P>0.05);髂骨嵴弧高与第2、3掌骨头弧高差异无统计学意义(Z值分别为-1.815、-1.386,P>0.05),髂骨嵴弧高与第4、5掌骨头弧高差异有统计学意义(分别对应Z=-3.152,t=-5.639,P<0.05)。结论:自体髂骨嵴与掌骨头在解剖学上有一定相似性,能够成为掌骨头移植的合适供体。

Objective：To explore the similarity between the iliac crest and the metacarpal bone,so as to provide an anatomical basis for the reconstruction of the metacarpal bone of the hand with the iliac crest grafting. Methods：There are 16 upper limb specimens and 10 pelvic specimens. The morphological features of the second,third,fourth and 5th metacarpal bones and iliac crest were observed. The following indexes were measured ：arc height and length of metacarpal head articular surface,volar dorsal metacarpal diameter,ulnoradial diamater,arc height and length of iliac crest,and inner and outer diameter. The obtained data were statistically analyzed to compare the morphological,structural features,arc length and diameter length of each metacarpal bone and iliac crest. Results：The arc length of the second metacarpal head,volar dorsal metacarpal diameter,arc height,and the ulnoradial diameter are 22.040（21.425,23.085） mm,（14.034±0.465） mm,4.185（4.113,4.598）mm,and（12.227±0.414） mm respectively. The arc length of the third metacarpal head,volar-dorsal metacarpal diameter,arc height,and the ulnoradial diameter are 23.430（22.743,24.153）mm,（14.316±0.430） mm,4.235（4.170,4.670） mm,and（12.382±0.425） mm respectively. The arc length of the fourth metacarpal head,volar dorsal metacarpal diameter,arc height,and the ulnoradial diameter are 21.960（21.245,22.285） mm,（12.382±0.288） mm,4.125（4.030,4.305） mm,and（11.991±0.362） mm respectively. The arc length of the fifth metacarpal head,volar dorsal metacarpal diameter,arc height,and the ulnoradial diameter are 20.030（19.668,20.148） mm,（11.807±0.358） mm,4.015（3.880,4.205） mm,and（11.659±0.399） mm respectively. The inner and outer diameter of the iliac crest is 14.350（13.660,14.739） mm,and the arc length and height are（22.930±0.701） mm and（4.520±0.184） mm respectively. The difference between the volar dorsal metacarpal diameter of the second metacarpal head and the inner and outer diameter of the iliac crest has no significant;while the volar dorsal metacarpal diameter of the third,fourth and fifth metacarpal heads are apparently longer and shorter than the inner and outer diameter of the iliac crest,respectively. The differences are statistically significant. The differences between arc length of the iliac crest and arc length of the second,fourth and fifth metacarpl head are statistically significant. However,the difference of arc length between the third metacarpal head and the ilium,as well as the difference of arc height between the second and third metacarpal heads and the iliac crest have no statistical significances,while the arc height of the fourth and fifth metacarpal heads are obviously smaller than that of the iliac crest. Conclusion：Autologous iliac crest is similar with metacarpal bone in anatomy,which might be a suitable donor for metacarpal bone transplantation.