microCT下钩骨骨内微小动脉三维构筑的临床解剖学研究

Three-dimensional architecture of intraosseous vascular anatomy of the hamate: a micro-computed tomography study

目的:获得钩骨内微小动脉三维构筑模型,为钩骨骨折后血供保护提供解剖学基础。方法:将红色氧化铅研磨至40μm以下,按铅丹和松节油1 g∶1.5 m L、1 g∶1 m L和1 g∶0.5 m L比例混匀制成铅造影剂。3个新鲜上肢肱动脉插管,灌注铅造影剂。钩骨取材,使用micro CT扫描钩骨,扫描设置为Binning 1,系统分辨率为highmed,重建设置为Down sample factor 2,图像最终分辨率为27.30μm。最终获得钩骨周围与钩骨内血管在各个切面的图像,重建形成钩骨内微动脉分支分布的三维构筑。结果:钩骨表面血管分布密集,主要分布在钩骨周围的韧带和肌腱内。钩骨表面主要有4大血管分布区域,分别位于钩骨体掌侧平台、钩骨背侧、钩骨尺侧和钩骨钩顶端。钩骨钩接受了来自钩骨钩顶端、钩骨体掌侧平台和钩骨尺侧动脉网的骨内分支,钩骨体接收了钩骨掌侧平台、钩骨背侧和钩骨尺侧的动脉骨内分支,并且骨内动脉相互吻合。结论:钩骨体和钩骨钩的骨内微小动脉各自存在多个来源并有丰富的吻合,出现缺血性钩骨坏死的概率较小,钩骨钩骨折后骨折不愈可能是由于对线不良等其他原因造成的。

Objective:To obtain three-dimensional intraosseous artery of the hamate and to provide the vascular anatomy basis of hamate fracture fixation.Methods:PbO(lead monoxide,Sinopharm Chemical Reagent Beijing Co.Ltd)was ground into particles less than 40μm and suspended in turpentine oil(Chemical Reagent Beijing Co.Ltd)at ratios of 1 g∶1.5 mL,1 g∶1 mL and 1 g∶0.5 mL.Three specimens were investigated.Brachial arteries were cannulated and perfused with lead-based contrast agent.Hamates were harvested and scanned using micro-computed tomography(microCT).The acquisition protocols were as follows:CT scan setup:total rotation[Degrees],360;rotation steps,360;X-ray detector setup:transaxial,2048;axial,2048;exposure time,1 500 ms,Binning,1;system magnification:high-med.X-ray tube setup:80 kV,500 mA current.The down-sampling factor used in the reconstruction was 2.The effective voxel size of the final image was 27.30μm.The three-dimensional model of the hamate was generated and the distribution and pattern of vessels were evaluated.Results:There were abundant extraosseous vessels around the hamate.They were mainly running in the tendons and ligaments around the hamate.Four vascular zones were identified on the hamate surface.They were on the palmar platform of the hamate body,on the dorsal side,on the ulnar side and on the tip of hamulus,namely.There were anastomoses among 4 vascular zones.We did not observe any vessels penetrating through the articular cartilage.The extraosseous vessels of the vascular zones gave a number of intraosseous branches into the hamate.The hamate body received intraosseous blood supply from the dorsal,palmar and ulnar while the hamulus from the palmar,ulnar and hamulus tip.There were some intraosseous branches anastomosing with each other.Conclusion:The extraosseous and intraosseous vessels of the ha-mate were more than what used to be considered.The hamate body and hamulus received blood supply from multiple directions and arteries anastomosed extensively both outside and inside the hamate,making it possible that the intraosseous perfusion survived after fracture.It is likely that the nonunion after the hamate fracture is not caused by the vascular damage but the malalignment of the fragments.