【摘要】 目的通过对手腕部血管进行灌注,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。方法选用成人新鲜上肢标本8例,进行以下试验:(1)前臂血管灌注:在前臂近端断面解剖分离出肱动脉断端,将已经磨顿圆的针头插入肱动脉断端3~4 cm,冲洗血管内淤血,过氯乙烯乙酸乙酯溶液混合氧化铅填充剂分别隔2 h、4 h、6 h、8 h各补充灌注1次,灌注结束将标本置于4℃冰柜冷存24 h后,CT观察月骨滋养动脉分布情况。(2)尸体解剖:显微镜下解剖游离桡动脉发出的腕掌支,然后暴露尺动脉并向远侧追踪尺动脉掌深支,继续探查尺动脉末端与桡动脉掌浅支吻合成的掌浅弓,并拍照记录。解剖前臂背侧:显露掌背皮动脉及腕背浅层血管网,游离行走于其内的桡动脉,并向远端追踪其走行,显露桡动脉腕背支、尺动脉腕背支、骨间前动脉腕背支。(3)肉眼观察月骨血管孔的分布、数量,并测量血管孔的口径。标本主要血管解剖完成并且拍照后,根据滋养孔大小、位置分别做好记录以备数据整理及统计学分析。结果 (1)月骨的血供来源于腕掌、背侧动脉网。掌侧的动脉是月骨的主要血供来源;(2)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;(3)月骨掌侧面血管孔数为(2.13±1.13)个,背侧面为(2.00±0.76)个。结论 (1)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;(2)月骨骨折线越靠近掌侧极,其发生缺血性坏死可能性越高;(3)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。更多还原

【Abstract】 Objective To find the relationships between ischemic necrosis of lunate and lunate nutrient arteries toprevent,diagnose and treat osteolytic ischemic necrosis of lunate better. Methods The following tests were carried out:(1)Forearm vascular perfusion:The distal end of the radial artery is dissected and dissected out of the cross section of theforearm,and the sharpened circular needle was inserted into the distal end of the radial artery 3-4 cm to wash blood in theblood vessels. Perchlorethylene acetate solution was mixed. After the end of perfusion,the samples were stored in a freezer at4℃ for 24 hours. CT observation of the nourishing artery of the lunate was performed.(2)Autopsy:the palmar branch of thefree radial artery was dissected under a microscope. Then the ulnar artery was exposed and the distal branch of the ulnar arterywas traced distally. The dorsal ulnar artery,and the interosseous bone were revealed. Anterior arterial carpal branch.(3)Visuallyobserve the distribution and number of vascular holes in the lunate and measure the caliber of the vascular holes,records weremade according to the size and position of the nourishing holes for data compilation and statistical analysis. Results(1)Theblood supply of the lumbar bone originates from the carpal and dorsal artery network. The palmar artery is the main source ofblood supply for the lunate bone.(2)The lunate bone and the surrounding carpus are mostly in contact with the articular carti-lage. The blood supply mainly depends on the nourishing vessels of the anterior ligament of the wrist. The number of vascularholes was 2.13±1.13,and the dorsal surface was 2.00±0.76. Conclusions(1)The large and medial holes of volar lunate aremore than dorsal lunate,which is more in small holes,and the vascular holes of the volar lunate are mostly distributed in medi-al area.(2)The nearer the lunate fracture line moves to the volar pole,the higher the possibility of lunate ischemic necrosisis.(3)The medial region of the volar lunate should be protected during open reduction and internal fixation.更多还原