股骨下端骺微血管的观察

本文报道用微血管造影及组织切片的方法,观察了18例胚胎和10例儿童的股骨下端骺。结果发现仅关节软骨内无血管。而软骨骺内的血管分布有一定规律:从髁间窝来的血管分布于骺中心区域;两髁侧面来的血管分布于两髁外侧份;骺软骨板附近的血管主要来自髌面上方及髁间窝上方。骺骨化中心最早围绕软骨管发生。骨化向周围扩展的速度不均匀,靠近血管处比远离血管处扩展块。骺未化骨时,其内的血管处于软骨管内,在化骨过程中,部分转变为骨骺血管,继续供应骺骨化中心: 2岁前,仅由3～5支来自髁间窝的血管供应;2岁后,髌面上方来的血管也开始进入;5岁后,两髁侧面来的血管相继开始供应骺骨化中心。     

髌骨血供及其临床意义

通过动脉灌注,对120侧不同年龄(新生儿～87岁)尸体的髌骨的血液供应进行了研宄。髌骨的动脉有髌主要动脉、下极动脉和髌底动脉,分别发自髌前动脉丛和髌周动脉环,成人在胃内互相吻合。对髌骨血管分布的临床意义进行了简要的讨论。     

股骨近侧端动脉的分布与吻合

通过动脉灌注,对100侧不同年龄(新生儿～67岁)尸体的股骨近侧端的血液供应进行了研究。囊外动脉环围绕股骨颈基部,由旋股内、外侧动脉组成,完整者占71％;囊内动脉环位于关节软骨缘滑膜下,由内侧、后、外侧和前颈升动脉组成,多见此环前部、后部和前、后部合并缺损,占74％。外骺动脉向关节软骨发出多级动脉弓,分布于股骨头的上、内、中央和外侧区。内侧颈升动脉分布于股骨头下后区。内骺动脉分布于有限的股骨头凹下区。关节软骨游离面由接近关节软骨缘和股骨头凹周缘的滑膜血管网及滑液营养,它的深部近骨—软骨接合处,由骺毛细管襻供给营养。上干骺部动脉分布于股骨颈外2/3,内侧颈升动脉和前、后颈升动脉短支分布于股骨颈相应区。在骺软骨骨化过程中,骺动脉与内侧颈升动脉在骨骺中建立一定的吻合弓。骺软骨板在成年骨化后消失,干骺部动脉穿入骨骺,与骺动脉建立广泛吻合。本文对股骨近侧端动脉的形态、行经、分布及其与临床的意义进行了讨论。     

股骨下端动脉的分布与吻合

通过动脉灌注,本实验研究了100侧不同年龄(新生儿至87岁)尸体标本股骨下端的血液供应,其血液主要来自膝上内、外侧动脉、膝降动脉和膝中动脉。除膝中动脉外,上述动脉均围绕股骨髁上部,组成囊外动脉环。完整者占55±4.97%,前部借骨膜动脉网间接相连者占45±4.97%。骺软骨板干骺侧的动脉呈刷状排列,以陡转的毛细血管袢紧接肥大软骨细胞层。干骺前、后动脉发自囊外动脉环和网,分布于髁上部。骺内、外侧动脉各发自膝降动脉和膝上内、外侧动脉,分布于内、外侧髁的内、外侧区。骺前和骺髁间动脉各发自骨膜动脉网和膝中动脉,分布于髁间区。骺动脉在骨化区互连成毛细血管前动脉和毛细血管网,在骨骺中,藉管径25～100μm的吻合支连接成丛。随骺板的闭合,干骺动脉与骺动脉之间乃建立广泛吻合。本文对股骨下端动脉的形态、经过、分布及其临床意义进行了讨论。     

胎儿新生儿股骨近端血运分布的研究

<正> 本文通过灌注造影、切片观察探讨了胎儿新生儿股骨近端血运变化的特点:结果如下:(1)骨骺动脉是胎儿、新生儿股骨头的主要血运来源,未见到圆韧带动脉和干骺端动脉进入该区;(2)干骺端的毛细血管袢自胎儿16周起已完好地形成,未见血管穿通骺板进入骨骺。作者还观察了不同时期胎儿和新生儿软骨管形态和结构,探讨了骺板     

带血管蒂髌骨移位修复胫骨内侧髁上关节面缺损的解剖与临床

目的：探索用带血管蒂髌骨移位的方法，修复胫骨内侧髁上关节面缺损。方法：用经动脉乳胶灌注的下肢标本37侧，经解剖、厚切片和铸型等方法研究髌骨的血管；观测30块髌骨和胫骨内侧髁上关节面的形态和面积。结果：供应髌骨血液的动脉有多条，这些血管先在髌骨周围相互吻合成髌周动脉环，再由该环发支供应髌骨。于髌骨内下方参与形成髌周动脉环的膝降动脉关节支的髌下支或膝下内动脉干长、位置恒定。髌骨和胫骨内侧髁上关节面的形态和面积相似。结论：带血管蒂髌骨可以移位至腔骨内侧髁，利用髌骨的关节面修复胫骨内侧髁上关节面的缺损，以保留膝关节的功能。     

跟骨血供及其临床意义

通过动脉灌注,对56侧不同年龄(新生儿至67岁)尸体跟骨的血液供应进行了研究。跟骨的动脉分散发自胫后动脉、足底内、外侧动脉、腓动脉、跗外侧动脉、跗骨管动脉和跗骨窦动脉,围绕跟骨组成致密的骨膜动脉网。此网发辐射状动脉至骨内,籍吻合支互连成丛。随骺(软骨)板闭合,于骺动脉与骺动脉之间建立广泛吻合。对跟骨血管分布的临床意义进行了讨论。     

软骨膜环及其微循环的观察

本文用微血管造影及组织切片的方法,观察人及家兔发育期管状骨软骨膜环的结构及血液供应。软骨膜环位于干骺端及骺软骨板周围,由3层结构构成,从内向外分別为骨环、间充质细胞带及软骨膜。间充质细胞带内有丰富的血管,它们来自干骺端骨膜。周围的软骨膜很厚,其内也有较丰富的血管,这些血管是骺与干骺血管在骨外交通的桥梁,有些血管可穿过软骨膜环的间充质细胞带供应骺软骨板。本文还对软骨膜环在骨生长发育过程中的功能进行了讨论。     

膝关节动脉血液供应的初步观察

本文选择固定和新鲜尸体下肢标本57侧,采用局部解剖、动脉铸型、动脉造影和标本透明等方法,对膝关节动脉血液供应作了初步观察。动脉关节支起点变异和共干形式,以右侧居多。膝区各动脉均有特殊的形态和一定的分布区域,在每一局部几个血液供应来源中,总有一个主次关系和层次关系。膝区动脉按口径大小,可以分成3组。口径的变化除了可以评价局部血液供应丰富的程度外,也是衡量相邻动脉大小的指征。整个膝区动脉血液供应配布比较均匀对称。供应膝关节的各动脉起点的高度是恒定的,相互间保持一定关系。本文还就纯关节支和肌关节支的概念、动脉吻合、局部“乏血管区”、髌前动脉网与髌骨血液供应的关系等进行了简单讨论。     

婴幼儿胫骨软骨管的形态特征及临床意义

用血管灌注方法对40侧出生到3岁婴幼儿胫骨骺内的软骨管进行了研究。软骨管起源于软骨骺骨膜动脉,主要经骺的前、后面进入骺内。关节软骨内无软骨管。近侧骺生长板内偶有血管穿过。对软骨管的形态特征与临床关系进行了讨论。     

The arterial blood supply of the human patella

The architecture of the arteries supplying the patellar rete was examined in 14 anatomic specimens in order to develop an optimized operating technique for knee joint transplantation. The specimens were fixed in Jores Solution and exarticulated from the hip joint. The lower limbs were injected with Berliner-Blau-Gelatin, and the arteries were dissected macroscopically. Five to six main arteries entered the patellar rete at 1, 3, 5, 7 and 11 o’clock forming an arterial circle. These arteries were the same main arteries which supply the distal end of the femur and the proximal part of the tibia. From an anatomic perspective, they provide the complete arterial blood supply to a whole knee joint being transplanted including the patella. Based on these anatomic results, we transplanted two allogenic vascularized human knee joints preserving the patella, the capsule, and the patellar ligament. Up to six months after surgery we demonstrated the perfusion and viability of all three transplanted bones, particularly the patella, by 99mTc DPD scintigraphy. We compared these findings with knee joint arthroscopy and with histologic results from biopsies taken from the patella. The postoperative examinations clearly indicated the viability of the transplanted patella employing this new operating technique. The results of the entire study demonstrate that it is technically feasible to transplant a whole knee joint which remains clinically viable.     

Vascular anatomy of the patella: Implications for total knee arthroplasty surgical approaches

BackgroundIatrogenic disruption of the patellar vascular supply has been identified as a possible contributing factor to the commonly reported patellofemoral complications following total knee arthroplasty (TKA). We performed an anatomic cadaveric study evaluating the extra-osseous vascular anatomy of the patella, and correlated our findings to routine TKA surgical dissection to determine how to better preserve patellar vascularity.Methods and materialsIn twenty-one cadaveric knees arterial cannulas were placed proximally and distally to the patella. A polyurethane compound was then injected producing a visible arterial network. Specimens underwent gross dissection.ResultsIn all 21 specimens, the supreme genicular (SGA), medial/lateral superior genicular (MSGA/LSGA), medial/lateral inferior genicular and anterior tibial recurrent arteries communicate forming a peripatellar anastomotic ring supplying the intraosseous patellar system. Both the SGA (24%) and MSGA (76%) demonstrated dual medial ring contribution. Relating the arterial location to common TKA exposures suggested severe compromise of patellar vascularity.ConclusionThe medial sided vessels seem to contribute more significantly to the peripatellar anastomotic ring when compared to the lateral sided vessels. Careful soft tissue management has the potential to preserve key vascular structures that could maintain the intraosseous vascular supply to the patella. Understanding the anatomic locations of major arterial systems around the knee joint can potentially help during hemostasis, and can minimize blood loss during TKA.Clinical relevanceRecognition of major arterial systems around the knee joint has the potential to minimize iatrogenic disruption of the vascular supply and the complications that can follow (patella devascularization and blood lost).     

兔膝关节解剖学特点及在动物模型的意义

目的　研究兔膝关节血管分布及关节囊附着，为兔膝关节动物模型建立提供解剖学基础。  方法     将20只新西兰大白兔麻醉后，4%多聚甲醛灌注固定。解剖分离兔膝关节的动脉来源及分支、暴露兔膝关节囊的附着点。测量各动脉起始处及其在水平方向上和关节囊附着点距髌骨下极的距离。  结果    分布兔膝关节的各动脉距髌骨下极的距离上、下和左、右约为20 mm和5 mm，关节囊的上、下端和左、右侧的附着点距髌骨下极约为10 mm和4.5 mm。  结论　在制备兔膝关节模型时，髌骨下极可设为参考的基准点，并通过距其距离判断手术安全范围。     

Cartilaginous bone extremities of growing monotremes appear unique

Cartilage canals are present in the epiphyseal cartilage of most mammals and birds. They are considered necessary for the maintenance of chondrocytes and for the formation of epiphyseal ossification centers. The epiphyseal cartilage of marsupials was recently shown not to contain cartilage canals, and placental rats appear not to have cartilage canals, although some confusion exists in the literature. The present study examines the cartilaginous epiphyses and physes from the knee and hip of the rat and the two Australian monotremes (platypus, Ornithorhynchus anatinus and echidna, Tachyglossus aculeatus). In all three species, cartilage canals were absent. Vessels to epiphyseal ossification centers were present, however. In the center of the cartilaginous femoral head of the echidna, but not in the platypus or rat, there was a large cavity, which contained connective tissue and was lined by an endochondrium of chondroproginator cells. These appeared to be contributing to growth of the cartilaginous epiphysis. No similar structure has previously been described in the cartilaginous epiphysis of other species. There was no ligament of the femoral head in the hip joints of the monotremes, and it is suggested the absence of a ligament may be significant in the development of the cavity. It was noted in all specimens that despite being avascular the epiphyseal and physeal cartilage appeared viable and functionally normal. The small size of the cartilaginous epiphyses of the rat may account for their avascularity; but the epiphyses of the monotremes were much larger, especially the echidna, yet still avascular. These features provide strong evidence for fundamental differences between the avascular cartilage of monotremes and the vascular cartilage of most mammals.     

Finding an ideal site for intraosseous infusion of the tibia: an anatomical study

Intraosseous infusion is a technique used for the administration of fluids to a hemodynamically shocked child in whom attempts to access the vascular system have been unsuccessful. Although few complications are seen, injury to the epiphyseal growth plate during the performance of this technique remains a serious problem. This study investigates the relationship between the site of insertion of the intraosseous needle and the epiphyseal growth plate, and the ease of needle insertion into various locations of the tibia in newborn infants. Fourteen newborn infant cadavers (28 tibias in total) were dissected after placement of four needles: 1). through the tibial tuberosity (Site A); 2). 10 mm distal to the tibial tuberosity (Site B); 3). 20 mm distal to the tibial tuberosity (Site C) and; 4). 10 mm proximal to the tibial tuberosity (Site D). Distances from the distal end of the epiphyseal growth plate were measured. A high number of needle placements at Site A were inserted into the epiphyseal growth plate. Most placements at Site B were between 10 and 16 mm from the epiphyseal growth plate on the right side and between 10 and 15 mm on the left side, and all were inserted without difficulty. Although far from the epiphyseal growth plate, most placements at Site C were very difficult to insert because of the thick cortical bone. All placements at Site D entered the epiphysis or the epiphysis and joint space of the knee. An insertion site of at least 10 mm distal to the tibial tuberosity is therefore recommended to avoid epiphyseal growth plate injury and ensure ease of insertion.