头状骨形态和血供的解剖学基础

Anatomical basis of the morphology and blood supply of the capitate bone

目的观察头状骨的形态和血供模式,探讨头状骨缺血性坏死的发生机制,为临床上头状骨移位治疗晚期Kienb?ck病提供解剖学依据。方法选取12例新鲜腕关节标本,从尺动脉或桡动脉灌注明胶-氧化铅溶液,经Micro-CT扫描,通过Mimics软件三维重建图像,观察头状骨形态和主要血供来源,测量头状骨和月骨的长度、宽度、厚度及近端关节面的直径、弧长和弧高,记录头状骨滋养血管孔的数量和分布情况,并对相关数据进行统计学分析。结果(1)F型头状骨75%(9例),S型头状骨25%(3例);(2)头状骨血供来源于掌侧和背侧,以背侧为主;(3)比较头状骨和月骨的长度、宽度和厚度及近端关节面的直径、弧长和弧高,具有明显的相关性;(4)头状骨滋养血管分布于距基底部2.2 mm处,其远端滋养孔数多于近端,差异有统计学意义(P<0.05)。结论头状骨的近端是以远端逆行供血为主,这是导致头状骨缺血性坏死的主要原因;头状骨移位治疗晚期Kienbock病具有可行性。

Objective To provide the anatomic basis for the clinical treatment of advanced Kienbock disease by transposition of the capitate bone through observing the morphology of the capitate bone and blood supply pattern and exploring the mechanism of avascular necrosis of the capitate bone.Methods Twelve fresh wrist joint specimens were selected,gelatin-lead oxide solution was perfused from the ulnar artery or radial artery.After scanned by Micro-CT,the image was reconstructed by Mimics software to observe the morphology of the capitate bone and the main blood supply source.The length,width,thickness of the capitate bone and lunate bone and diameter,arc length,arc height of the proximal joint surface were measured.The number and distribution of the capitate bone nourished blood vessels were recorded,and the relevant data were statistically analyzed.Results(1)There were 9 cases of F-shaped capitate bone(accounting for 75%),and 3 cases of S-shaped(accounting for 25%);(2)Blood supply of capitate bone originated from the volar surface and the dorsal surface,with the dorsal surface mainly;(3)Compared the length,width,thickness,the diameter,arc length and arc height of the capitate bone and the lunate bone,there were significant correlation among them;(4)The nourishing vessels of the capitate bone were distributed at 2.2 mm from the base,the number of nourishing vascular foramina on the distal pole was more than that of the proximal pole,the difference was statistically significant(P<0.05).Conclusions The proximal capitate bone is mainly dominated by the distal retrograde blood supply,which is the main cause of avascular necrosis in the capitate bone.It is feasible to treat the advanced Kienbock disease by transposition of the capitate bone.