Objective To study the anatomical characteristics of blood supply of lunar bone by three-dimensional reconstruction of Micro-CT data of nutrient vessel of lunar bone, explore the anatomical mechanism of ischemic necrosis of lunar bone. Methods The study had passed the ethical review of Kunming General Hospital of Chengdu Military Region. Twelve fresh adult wrist specimens were perfused with red lead oxide contrast medium and scanned under Micro-CT. The blood supply of lunar bone was reconstructed by Mimics software to measure and analyze statistically the anatomical parameters of nutrient vessels. Results (1) The diameter of nutrient pore on the metacarpal side of the lunate was (0.62±0.11) mm, and the diameter of the vascular entrance was (0.59±0.17) mm in volar side of lunate. There was no significant difference between the dorsal side (0.59±0.13) mm and (0.61±0.12) mm (P>0.05). The mean number of nutrient foramen on the metacarpal surface of lunar bone was (3.67±2.74) and that on the dorsal side was (2.41±1.83). The difference was statistically significant (P<0.05). However, there were no statistical difference between the mean number of nutrient foramen, the diameter of nutrient pore and the diameter of the vascular entrance of Type I and Type II. (2) The distribution of nutrient vessels in lunar bone was classified into 3 types, which was Y-shaped in 50% (7 cases), I-shaped in 35.7% (5 cases) and X-shaped in 14.3% (2 cases). Conclusions The blood supply of the metacarpal face of lunar bone is abundant, and the ischemic necrosis of lunar bone is more likely to occur after injury. The distribution of nutrient foramen in the proximal ulnar part of the metacarpal surface of the lunar bone is concentrated, and the intervention of ligaments and soft tissues in this area should be minimized during the operation.
Key words
Lunar bone /
Nutritive artery /
Vascular perfusion /
Anatomy /
Three-dimensional reconstruction
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Pang EQ, Douglass N, Kamal RN. Association of lunate morphology with carpal instability in scapholunate ligament injury[J]. Hand(N Y), 2018, 13(4): 418-422.
[2] Bain GI, Clitherow HD, Millar S, et al. The effect of lunate morphology on the 3-dimensional kinematics of the carpus[J]. J Hand Surg Am, 2015, 40(1): 81-89.
[3] Viegas SF. Variations in the skeletal morphologic features of the wrist[J]. Clin Orthop Relat Res, 2001, 23(383): 21-31.
[4] Freedman DM, Botte MJ, Gelberman RH. Vascularity of the carpus[J]. Clin Orthop Relat Res, 2001, 2(383): 47-59.
[5] Marissa, Boutin RD, Bayne CO, et al. Association of lunate morphology, sex, and lunotriquetral interosseous ligament injury with radiologic measurement of the capitate-triquetrum joint[J]. Skeletal Radiol, 2017, 46(12): 1729-1737.
[6] Mauler F, Beaulieu JY. Morphological associations between the distal radioulnar joint and the lunate[J]. J Wrist Surg, 2018, 7(2): 148-155.
[7] Park JH, Jang WY, Kwak DH, et al. Lunate morphology as a risk factor of idiopathic ulnar impaction syndrome[J]. Bone Joint J, 2017, 99-B(11): 1508-1514.
[8] Toffoli A, Lenoir H, Lazerges C, et al. Clinical outcomes of proximal row carpectomy by preoperative midcarpal joint morphological classification: viegas type I versus type II[J]. Hand Surg Rehabil, 2017, 36(3): 181-185.
[9] van Alphen NA, Morsy M, Laungani AT, et al. A three-dimensional micro-computed tomographic study of the intraosseous lunate vasculature: implications for surgical intervention and the development of avascular necrosis[J]. Plast Reconstr Surg, 2016, 138(5): 869e-878e.
[10] Kadar A, Morsy M, Sur YJ, et al. The vascular anatomy of the capitate: new discoveries using micro-computed tomography imaging[J]. J Hand Surg Am, 2017, 42(2): 78-86.
[11] 徐永清, 钟世镇, 徐达传, 等. 腕关节韧带解剖及组织学特性研究[J]. 中华创伤骨科杂志, 2005, 7(12): 1147-1151.
[12] 王大伟, 高飞, 单贵霖, 等. 月骨滋养动脉应用解剖学研究及其临床意义[J]. 解剖学研究, 2018, 40(3): 210-214.
