头状骨移位替代坏死月骨的解剖研究及其临床应用

目的　介绍一种治疗晚期月骨无菌性坏死的新术式。方法　对 5 0侧上肢标本进行显微解剖并观测腕部的血管结构。对 10 0侧腕骨标本中头状骨与月骨进行对比观测 ,并做相关性分析。设计以骨间前动脉背侧支为蒂的头状骨移位术 ,替代坏死碎裂的月骨。临床应用 2 0例 ,术后随访 1～ 13年。结果　头状骨与月骨的几何形状、外径和关节面的弧高、弧长极其相似 ,相关性显著。移位的头状骨有可靠的血运。 2 0例头状骨移位替代坏死月骨者术后腕痛消失 ,保持了腕高、腕骨间的稳定和腕关节的功能。结论　该术式符合腕关节的功能解剖和力学传导 ,是治疗晚期月骨无菌性坏死的较好方法。

Capitate transposition for treatment of avascular lunate necrosis: applied anatomy and clinical application

Objective To introduce a new surgical procedure for treatment of avascular lunate necrosis in advanced stage. Methods 50 cadaveric upper extremities were dissected using micro anatomic technique and the vascular structure of the wrist observed. The capitate and lunate of 100 wrists were compared and their relevance analysed. Capitate transposition based on the dorsal branch of the anterior interosseous artery in place of lunate was designed and applied in 20 cases clinically. Postoperative follow up ranged from 1 to 3 years. Results The geometrical appearance, diameter, the height and length of capitate articular arc were similar to those of the lunate.The compatibility is obvious.The transposed capitate had a reliable blood supply. Clinical application proved that capitate transposition not only eliminated wrist pain by excision of the necrotic and fragmentary lunate, but also preserved the stability and function of the wrist. Conclusions This procedure is rational because it is in accordance with the functional anatomy and biomechanical rules of the wrist.lt is an effective method for treatment of avascular lunate necrosis in advanced stage.