尺动脉腕上皮支降支蒂豌豆骨移位替代月骨的解剖基础

目的为尺动脉腕上皮支降支蒂豌豆骨移位替代月骨提供解剖学依据.方法用50侧动脉灌注红色乳胶的成人上肢标本,对尺动脉腕上皮支来源、走行、分支及分布范围进行解剖学观测;在40侧成人干燥手骨上测量了豌豆骨和月骨的形态学数据;1侧新鲜标本摹拟手术设计.结果①豌豆骨纵径和月骨横径接近,分别为(12.8±1.5)mm和(12.5±1.5)mm;②尺动脉腕上皮支在豌豆骨近侧3.9cm处起于尺动脉,分为升支和降支.其中降支与尺神经手背支伴行下降,经尺骨头与豌豆骨之间进入手背尺侧,沿途除发支供养尺侧腕屈肌腱、小鱼际、手背尺侧皮肤外,还发出3～7支外径(0.3～0.7)mm的分支营养豌豆骨.结论以尺动脉腕上皮支降支为蒂豌豆骨移位替代月骨,血供可靠,简便易行.     

月骨的血供及其临床意义

在87侧成人干燥月骨、12侧透明腕标本、20侧乳胶灌注标本上观察了月骨的血管孔、骨内、外动脉及其与周围结构的关系。掌侧的动脉是月骨的主要血供来源,在长期、反复强力伸腕的情况下容易受到损伤,这可能是月骨缺血性坏死的主要原因.     

带血管蒂头状骨移位替代月骨的应用解剖

目的：设计一种治疗晚期月骨无菌性坏死的手术方法。方法：对５０侧上肢标本解剖观测腕部血管的构成、走行、分支和腕骨的血供；对１００侧腕头状骨和月骨的外径、关节面的弧高、弧长，进行对比观测，经统计学处理。结果：头状骨和月骨的外径和关节面的弧高、弧长极其相近；头状骨血供以背侧为主，骨间掌侧动脉背侧支通过腕背动脉网可供给其充足的血运。结论：可以骨间掌侧动脉背侧支为蒂设计头状骨移位替代月骨，术式符合腕关节的功能解剖和生物力学传导，是治疗晚期月骨无菌性坏死的一种有效方法。     

吻合血管第二跖骨头移植重建月骨的应用解剖

目的：为第Ⅲ、Ⅳ期月骨无菌性坏死的修复提供理想的替代体。方法：解剖观测了２２侧成人标本第２跖骨头的血供和神经分布，用万能工具显微镜测量了４０侧第２跖骨头关节面和３０侧月骨近侧关节面的纵、横截面曲率半径、长度和面积，进行了二者间的显著性检验。结果：第２跖骨头血管、神经位置恒定，其关节面与月骨近侧关节面的纵、横截面曲率半径间无显著性差异。结论：第２跖骨头与月骨形态、体积近似，取材方便，植入后稳固，吻合血管易于成活，为月骨重建的较为理想的替代体。     

microCT重建距骨骨内微小动脉三维结构的临床解剖学研究

目的获得距骨内微小动脉三维结构模型,对临床上不同分型的距骨骨折的预后做出更精确的解释和预测。方法对12例新鲜尸体下肢行股动脉插管并灌注铅造影剂。距骨取材,进行microCT扫描并且重建高精度模型,图像最终分辨率为52.30μm。最终获得距骨周围与距骨内血管在各个切面的图像,观察距骨表面动脉与骨内分支的走行和分布,并计数动脉的骨内分支数。结果距骨骨外血管集中分布于表面的韧带和关节囊内。距骨表面主要有4大血管分布区域,分别为跗骨管-跗骨窦区、距骨颈上表面、距骨体内侧面和后结节区。距骨颈周围血管环由跗骨管-跗骨窦区和距骨颈上表面的骨外血管连接而成(骨内分支数分别为5.1±1.3和5.6±1.9),是距骨的主要血供来源,分支分布于距骨头、距骨颈和大部分距骨体,并有丰富的吻合。此外,距骨体还接受距骨体内侧面(骨内分支3.2±1.4)和后结节区(骨内分支0.7±0.5)的骨内分支的血供。结论血管环是距骨的主要血供来源,骨内分支有丰富吻合。距骨颈骨折的坏死风险取决于该分型对血管环骨内分支和吻合的破坏程度。距骨体矢状面骨折和粉碎骨折对血管环的骨内分支的破坏较大,缺血坏死风险相对高。距骨头血供丰富,骨折时缺血坏死的可能小。     

带蒂肘前内侧骨皮瓣的解剖与临床应用

中对成人上肢标本40例解剖观测了尺侧下副动脉、尺侧返动脉的起始、走行、分布和吻合特点；并设计应用带血供的肘前内侧骨皮瓣转位术修复肘关节周围骨皮缺损8例。其中6例骨皮瓣全部成活，2例骨皮瓣的皮瓣边缘少许坏死感染，经短期换药而愈合。随访1．0～1．5年，供受区外形及功能均恢复良好。以上述血管为蒂的肘前内侧骨皮瓣，血管解剖恒定，血供丰富。     

跟骨及其周围结构的临床解剖学研究

目的：探讨跟骨及其周围结构的解剖学特点及其在跟骨骨折治疗中的意义。方法：30侧干燥跟骨标本分3组分别从冠状面、矢状面和水平面剖开，观察跟骨骨小梁排列。解剖13例26侧成人足部标本，观察跟骨周围的肌腱、血管、神经走行，以及关节囊和韧带的附着。对其中3侧新鲜足标本分别以红黑墨水灌注胫后动脉及腓动脉，观察跟骨及其足部皮肤的血供状况。结果：跟骨骨小梁的分布特点为内、后、上致密，外、前、下稀疏。胫后动脉主要供应跟骨前下部骨质和足底前2／3皮肤，腓动脉主要供应跟骨后上方骨质和足跟底部皮肤，胫前动脉则供应跟骨中央和足背绝大部分皮肤。结论：应根据跟部皮肤的血供选择手术切口。载距突和跟骨结节可作为跟骨骨折内固定的固定点。     

头状骨形态和血供的解剖学基础

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Kienb?ck病具有可行性。     

三维重建Micro-CT扫描下月骨滋养血管的临床解剖学研究

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。     

三维重建Micro-CT扫描下月骨滋养血管的临床解剖学研究

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。     

Anatomical bases of the pediculated pisiform transplant and the intercarpal fusion by Graner in Kienböck's disease

Summary Anatomic characteristics of the lunate, the pisiform and the capitate were compared in order to support the use of a pisiform transplant or the intercarpal fusion by Graner in advanced stages of Kienböck's disease. Fifty lunate and pisiform bone pairs and 20 wrist specimens served for morphological and functional investigations. In view of the present results, the pisiform, after a rotation of 90°, should be implanted in the lunate box with its longitudinal diameter oriented to the dorsopalmar plane. Despite the small pisiform volume, maintainance of carpal height is assured by its relatively large dorsopalmar diameter. The rotated position permits use of existing soft tissue structures and improves the conditions of force transmission. Measurements comparing the radii of curvature of the original lunate and the substitute pisiform surfaces show a good correspondence proximally and a reduction of the articular congruity distally, due to the flatness of the pisiform surface. The palmar convexity of the pisiform adapts better to the distal radius facet than the capitate head, which replaces the lunate in Graner's surgical procedure.

---

Bases anatomiques d'un greffon pédiculé du pisiforme et de l'arthrodèse intra-carpienne selon le procédé de Graner dans la maladie de Kienböck

Résumé Une étude morphologique comparative du lunatum, du pisiforme, et de l'os capitatum a été faite dans le but de préciser les possibilités d'utiliser une transposition du pisiforme ou une arthrodèse intra carpienne selon Graner dans le traitement des stades évolués de la maladie de Kienböck. Quinze paires de lunatum et de pisiforme et vingt poignets ont été utilisés pour des investigations morphologiques et fonctionnelles. Les résultats de cette étude montrent que le pisiforme, après une rotation de 90°, peut être implanté dans la loge du lunatum, en orientant son plus grand diamètre dans un plan dorso-palmaire. Bien que le pisiforme soit un os de petit volume, la hauteur carpienne reste conservée en raison de l'importance relative de son diamètre dorso-palmaire. Sa mise en place en rotation permet d'utiliser un apport spongieux et améliore la transmission des forces au niveau du poignet. Des mesures comparant les rayons de courbure des surfaces articulaires du lunatum originel et du pisiforme substitué, montrent une bonne correspondance du côté proximal et une diminution de la congruence articulaire du côté distal, liée à l'aplatissement de la surface du pisiforme. La convexité palmaire du pisiforme s'adapte mieux à la surface articulaire distale du radius que la tête de l'os capitatum, qui remplace le lunatum dans la technique de Graner.

     

人体腕骨显微骨硬度分布特征的研究

目的 探讨人体腕骨显微骨硬度的分布特征及其临床意义。方法 纳入3具新鲜冰冻成人尸体标本(62岁男性、58岁男性、45岁女性),将右侧腕骨软组织剥离后,用慢速锯分别在舟骨、月骨、头状骨、钩骨、大多角骨和小多角骨切取厚3 mm的骨组织标本。舟骨选取舟骨结节、腰部内外侧和舟骨体部,月骨选取腕关节面、掌侧面、背侧面和远端,头状骨、钩骨、大多角骨和小多角骨选取外层皮质不同区域,应用德国KB-5型显微维氏硬度仪测试标本不同区域的硬度值,采用50 gf力加载50 s、维持12 s的标准操作方法进行硬度值测定,每个区域选取 5 个有效值,全体有效值的平均值作为该部位的骨硬度值。观察不同骨骼间及骨骼内部不同区域的骨硬度值差异。结果 3具标本中共取得舟骨、月骨、头状骨、钩骨、大多角骨和小多角骨标本切片18片,测量位点255个。腕骨不同骨骼骨硬度从高到低依次为钩状骨(39.04±5.79)HV、头状骨(38.98±6.17)HV、舟骨(37.72±5.85)HV、大多角骨(35.89±4.75)HV、月骨(33.65±5.42)HV及小多角骨(31.82±5.54)HV,不同骨骼间总体骨硬度差异有统计学意义(F=10.783,P＜0.01)。舟骨、月骨内部不同区域骨硬度分布近似,舟骨结节、腰部外侧、腰部内侧和舟骨体部骨硬度分别为(37.07±5.77)、(37.51±6.39)、(40.00±5.64)、(36.31±5.47)HV,其中腰部内侧骨硬度最大,舟骨体部骨硬度最小,4部位间骨硬度比较差异无统计学意义(F=1.129,P＞0.05)。月骨腕关节面、掌侧面、背侧面和远端骨硬度分别为(33.57±3.61)、(34.58±6.04)、(35.47±5.24)、(30.97±5.88)HV,其中背侧骨硬度最大,远端骨硬度最小, 4个部位间骨硬度比较差异无统计学意义(F=2.040,P＞0.05)。结论 健康人腕骨不同骨骼间硬度各有不同,舟骨和月骨内部各部位骨硬度分布均匀一致。测量腕骨显微骨硬度值,了解其分布特征,有助于了解腕骨微观生物力学性能,亦可指导腕骨骨折内固定方法的选择,设计制作更加符合人体生理状态下的腕部骨骼假体及建立腕部肌骨组织的有限元模型。临床试验注册 中国临床试验注册中心,注册号为ChiCTR-BPR-17010818。     

异体颗粒骨打压植骨的研究进展

目的：探讨异体颗粒骨打压植骨的临床应用和相关研究的进展。方法：在CNKI数据库和Pubmed中检索近年来有关异体颗粒骨打压植骨的相关文献,从同种异体骨的准备、移植骨颗粒的大小及颗粒骨的打压紧密程度和厚度等方面总结异体颗粒骨打压植骨的临床应用和研究进展。结果：对异体颗粒骨在一定剂量范围内的辐照法灭菌彻底,对颗粒骨的生物力学影响较小。脱脂处理能够降低抗原性,提高植骨的成骨能力。直径7—10mm颗粒骨具有较好的初始稳定性。颗粒骨的打压应足够坚强,以确保假体旋转和轴向稳定性。结论：异体颗粒骨打压植骨的临床应用效果良好,制备颗粒骨之前进行灭菌、脱脂是很重要的过程,颗粒骨的大小、植骨的紧密程度和厚度还要进一步研究,临床应用时要从多方面综合考虑。     

Effects of dividing the transverse carpal ligament on the mechanical behavior of the carpal bones under axial compressive load: a finite element study

Transecting the transverse carpal ligament (TCL) is a routine procedure to surgically treat carpal tunnel syndrome; yet, its mechanical consequences on carpal bones are unclear. In this study, our intent was to perform a computational analysis of carpal biomechanics resulting from TCL release. A three-dimensional finite element model of the wrist was constructed, which included all the carpal bones, the distal ulna and radius, the proximal metacarpals and the interosseous ligaments. Cartilage layers of each bone were modeled manually according to anatomic visualization software. The TCL was also modeled in three dimensions and added to the bone model. A 100-Newton axial load was applied to the upper section of the second and third metacarpals. The effects of dividing the TCL on the displacements of the carpal bones and the contact stress distribution in the midcarpal joints were studied using a finite element analysis method. When the TCL was divided, the axial compressive load resulted in the carpal bones deviating more radially. More specifically, the carpal bones on the radial side of the capitate and lunate (i.e. the trapezium, trapezoid, and scaphoid) moved further toward the radius, and the carpal bones on the ulnar side of the capitate and lunate (i.e. hamate, triquetrum, and pisiform) moved further toward the metacarpals. The contact stresses and contact locations in the midcarpal joints changed as a result of dividing the TCL. The changes in displacements of carpal bones and the contact stress distributions in the midcarpal joints due to TCL release may be implicated for some of the postoperative complications associated with carpal tunnel release.     

Detailed anatomy of the antebrachiocarpal joint in dogs

A comparative study of the anatomy of the antebrachiocarpal (AC) articulation was carried out in 30 adult dogs with 60 joints. Although a considerable degree of similarity was found between the AC joint in dogs and the corresponding wrist joint in humans, a number of differences between these two homologous joints were also noted. The distal end of the ulna in dogs directly articulates with the ulnar carpal and accessory carpal bones forming a specialized antebrachiocarpal arrangement more adapted to running. The accessory carpal bone in dogs is a massive, long bone and is strikingly different from its homologue in humans, the pisiform bone. The joint between the accessory and ulnar carpal bones, which corresponds to the piso-triquetral joint in humans, is always connected with the AC joint, whereas in humans this communication could be found occasionally. The large radial carpal bone in dogs, characteristic for carnivores, corresponds to the fused scaphoid and lunate bones in humans, in whom this type of fusion is very rarely found. The palmar ulnocarpal and radiocarpal ligaments in dogs are distinctly intra-articular, whereas in humans these ligaments are intracapsular. One of the controversies of the AC joint in dogs is a structure located between the distalmost parts of the radius and ulna forming a strong bond between these two bones and a part of the antebrachial articular surface. It is cartilage-like and is composed of typical fibrocartilagineous tissue. Considering its location, form, and function, this structure in dogs should be regarded as the articular disc and so-named; it is also concluded that it is a homologue to the articular disc of the distal radioulnar joint in humans. © 1992 Wiley-Liss, Inc.     

Vascular Endothelial Growth Pattern During Demineralized Bone Matrix Induced Osteogenesis

The purpose of the current study was to determine the timely ingrowth of blood vessels associated with demineralized bone matrix (DMB) induced osteogenesis. Critical-size (10 × 5mm), full thickness bony defects in rabbit parietal bone were implanted with DBM. Histological and ultrastructural changes were examined 1, 2, 3, 4, 5, 6, 7 and 14 days later. Neovascularization was assessed by immunohistochemical staining for factor VIII antigen (marker for vascular endothelium) and also confirmed by staining using pan-endothelial antibody (CD31) (a marker for endothelium). Immunohistochemical evaluation revealed a positive staining for CD31 and Factor VIII expressed by endothelial cells by day 3 post grafting. By day 4, small blood vessels were first seen budding from host bed towards the grafted DBM. Ultrastructural identification of cells in the early stages of healing revealed the presence of macrophages. The monocyte-derived macrophage appears to play a central role in the repair process using DBM. Results of this study demonstrated a rapid vascularization during the DBM induced osteogenesis. This rapid vascularization is vital to the healing and bone induction ability of the DBM.     

舟骨及月骨的滋养孔观察

利用50副完整成人骨骼标本观察100例舟骨及月骨的滋养孔情况;发现舟骨滋养孔最多集中在其腰部的背面,其次是在腰部的掌面,舟骨结节上也存有滋养孔存在,滋养孔平均最多数是在其腰部的中间部、月骨滋养孔最多处在其背面的远侧部,滋养孔最少处是在其背面的近侧部.