滋养动脉与月骨坏死相关性解剖学研究

Anatomical study on the correlation between nourishing artery and lunate osteonecrosis

目的研究月骨滋养动脉与月骨缺血性坏死之间的联系，为临床更好地预防、诊治月骨缺血性坏死提供依据。方法选用成人新鲜前臂标本8例，经肱动脉灌注加氧化铅过氯乙烯，4℃冷存24h后CT扫描观察月骨滋养动脉分布情况，肉眼观察月骨血管孔的分布、数量；在显微镜视下解剖、观察月骨的血管与周围结构的关系并测量血管孔的口径。结果月骨的血供来源于腕掌、背侧动脉网，掌侧的动脉是主要来源。月骨与周围腕骨多是关节软骨相接触，缺乏骨膜和肌腱附着，其血液供应主要依靠腕前韧带的滋养血管。月骨掌侧面血管孔数均值为2．13个，背侧面为2．00个，掌侧面内侧区共14个，掌侧面外侧区共3个，背侧面共16个。结论月骨掌侧面大、中孔相对较多，背侧面小孔较多，且掌侧面血管孔多数分布于内侧区；月骨骨折线越靠近掌侧极，发生缺血性坏死的可能性越高；月骨骨折行切开复位内固定术时需避开月骨掌侧面内侧区。

Objective To study the correlations between the nourishing artery and the ischemic necrosis of the lunate bone in order to provide evidence for better prevention and treatment of ischemic necrosis of the lunate bone. Methods Eight adult fresh upper limb specimens were infused with perchloroethylene added oxidized lead through brachial arteries. After 24-hour cold storage at 4 ℃ , the distribution of the nourishing artery of the lunate bone was observed by CT scanning. The distribution and quantity of the vascular holes of the lunate bone were also observed. The relationship between the blood vessels of the lunate bone and the surrounding structures was observed, and the caliber of the vascular holes was measured. Results The blood supply of the lunate bone comes from the carpal palmar and dorsal artery network, and the palmar artery is the main source. The lunate bone and the surrounding carpal bones are mostly contacted with articular cartilage, lack of periosteum and tendon attachment, and their blood supply mainly relies on the nourishing vessels of the anterior carpal ligament. The average number of the palmar vascular holes was 2.13, the dorsal was 2.00, the medial area of the palmar lunate was 14, the lateral area of the palmar lunate was 3, and the dorsal lunate was 16. Conclusion The large and medium holes of the palmar lunate bone are more than those of the dorsal lunate bone which has more small holes. And the vascular holes of the palmar lunate bone are mostly distributed in medial area. The closer the bone fracture line is to the palmar pole, the higher the possibility of lunate ischemic necrosis is. The medial region of the palmar lunate bone should be avoided during open reduction and internal fixation for the lunate bone fractures.