三维重建Micro-CT扫描下月骨滋养血管的临床解剖学研究

Clinical anatomical study on three-dimensional reconstruction of nutritional vessels of lunar bone

目的通过三维重建月骨滋养血管灌注的Micro-CT扫描数据,研究月骨血供的解剖学特征,探讨月骨缺血坏死的解剖学机制。方法选用成人新鲜腕关节标本12例,红色氧化铅造影剂灌注血管后截取腕关节行Micro-CT扫描,并应用Mimics软件三维重建月骨血供,测量滋养血管解剖参数并作统计学分析。结果(1)月骨掌侧滋养孔径(0.62±0.11)mm,血管入口处直径(0.59±0.17)mm,较背侧(0.59±0.13)mm、(0.61±0.12)mm差异均无统计学意义(P>0.05);月骨掌面滋养孔平均数(3.67±2.74),背侧面为(2.41±1.83),差异有统计学意义(P<0.05);I型与II型月骨的平均滋养孔数、孔径及血管入口直径无统计学差异(P>0.05)。(2)月骨内滋养血管分布有3种模式,Y形50.0%(7例),I形35.7%(5例)和X形14.3%(2例)。结论月骨掌面血供丰富,损伤后容易发生月骨缺血坏死;月骨掌面尺侧近端的滋养孔分布集中,术中应尽量减少干预该区域的韧带和软组织。

Objective To study the anatomical characteristics of blood supply of lunar bone by threedimensional reconstruction of Micro-CT data of nutrient vessel of lunar bone,explore the anatomical mechanism of ischemic necrosis of lunar bone.Methods The study had passed the ethical review of Kunming General Hospital of Chengdu Military Region.Twelve fresh adult wrist specimens were perfused with red lead oxide contrast medium and scanned under Micro-CT.The blood supply of lunar bone was reconstructed by Mimics software to measure and analyze statistically the anatomical parameters of nutrient vessels.Results(1)The diameter of nutrient pore on the metacarpal side of the lunate was(0.62±0.11)mm,and the diameter of the vascular entrance was(0.59±0.17)mm in volar side of lunate.There was no significant difference between the dorsal side(0.59±0.13)mm and(0.61±0.12)mm(P>0.05).The mean number of nutrient foramen on the metacarpal surface of lunar bone was(3.67±2.74)and that on the dorsal side was(2.41±1.83).The difference was statistically significant(P<0.05).However,there were no statistical difference between the mean number of nutrient foramen,the diameter of nutrient pore and the diameter of the vascular entrance of Type I and Type II.(2)The distribution of nutrient vessels in lunar bone was classified into 3 types,which was Y-shaped in 50%(7 cases),I-shaped in 35.7%(5 cases)and X-shaped in 14.3%(2 cases).Conclusions The blood supply of the metacarpal face of lunar bone is abundant,and the ischemic necrosis of lunar bone is more likely to occur after injury.The distribution of nutrient foramen in the proximal ulnar part of the metacarpal surface of the lunar bone is concentrated,and the intervention of ligaments and soft tissues in this area should be minimized during the operation.