带血管蒂髌骨移位修复膝关节面缺损的应用解剖

目的：为带血管蒂髌骨移位修复股骨髁和胫骨髁关节面缺损提供解剖学基础。方法：用34侧经动脉红色乳胶灌注的下肢标本，经解剖和铸型研究髌骨的血供。观测30块髌骨和胫骨内外侧髁上关节面的形态和面积。结果：供应髌骨的各支动脉先在髌骨周围吻合成髌周动脉环，再由该环发支进入髌骨。参与形成髌周动脉环的主要动脉有膝上外动脉、膝下外动脉、膝降动脉髌上支、膝降动脉髌下支和膝下内动脉。髌骨关节面与股骨内外侧髁关节面、胫骨内外侧髁上关节面形态大小相似。结论：带血管蒂髌骨可以移位至股骨内外侧髁、或胫骨内外侧髁，利用髌骨的关节面修复股骨髁或胫骨髁关节面缺损，以期最大限度保留膝关节的功能。

Applied anatomy of the pedicled patella translocation for repairing the defect of knee joint surface

Objective: To provide anatomic basis for repairing the knee joint surface defect with the pedicled patella translocation. Methods: The patellar blood supply was studied by the dissection of 34 adult lower limbs that were perfused with red emulsion. The shape and area of the joint surface of 30 patella and tibial condyles were observed and evaluated. Results: The arteries supplying the patella formed a ring around patella and then the ring sent smaller branches into the bone. The lateral superior genicular artery, the lateral inferior genicular artery, the superior patella branch and inferior patella branch of the descending genicular artery and the medial inferior genicular artery constituted the ring together. The articular surface of patella was similar to the joint surface of femoral medial and lateral condyles, as well as the superior joint surface of tibial medial or lateral condyles in shape and area. Conclusions: Pedicled patella can be transposed to medial or lateral condyles of tibia and femur. It can be used for repairing knee joint surface defect and reserving the knee function utmostly.