Potential donor rotational bone grafts using vascular territories in the foot and ankle.
Potential donor rotational bone grafts using vascular territories in the foot and ankle.
复制标题
使用足部和踝部血管区域的潜在供体旋转骨移植。
DOI：
10.2106/00004623-200409000-00002
复制
发表时间：
2004
期刊：
影响因子：
--
通讯作者：
J. Nunley
中科院分区：
文献类型：
--
作者：
B. J. Gilbert;F. Horst;J. Nunley
背景
更好地了解胫骨远端、腓骨远端、长方体和楔骨的骨外和骨内血液供应，应确定血管区域，使外科医生能够在足部和踝部进行旋转血管蒂骨移植手术。
方法
我们使用两种血管注射技术研究了二十具尸体下肢的血液供应。为了确定该区域的骨外和骨内动脉解剖结构，根据改良的 Spalteholz 技术，对 10 个标本依次注射 Batson 化合物、软组织消化和骨清除。为了进一步表征骨外血管解剖结构，其他十个标本被注射乳胶并进行解剖。
结果
我们发现了胫骨远端、腓骨远端、长方体和楔骨的一致且先前未命名的血液供应。我们所有的标本中都存在四根血管，为骨骼提供了独特的血管区域。近侧跗骨动脉的一个分支在长方体中提供了一致的血管区域，平均有 15 个营养血管。类似地，第一楔骨远端内侧跗骨动脉的分支平均提供了九个优于胫骨前肌腱插入的营养血管。前外踝动脉到腓骨的分支平均为外踝提供七个营养血管。远端跗骨外侧动脉的一个分支为第三楔骨的中段提供了平均七个营养血管。在注射乳胶的标本中，根据这些数据设计的带血管蒂骨移植物的收获证明了它们的解剖学合理性和旋转弧。
结论
在足部和踝部发现了四个新的旋转带血管蒂骨移植物。这些移植物存在于我们所有的标本中，血管化良好，具有宽的旋转弧，并且相对容易收获。
BACKGROUND
An improved understanding of the extraosseous and intraosseous blood supply of the distal aspect of the tibia, distal aspect of the fibula, cuboid, and cuneiforms should identify vascular territories that would enable surgeons to perform rotational vascularized pedicle bone-grafting procedures in the foot and ankle.
METHODS
We investigated the blood supply of twenty cadaveric lower extremities using two vascular injection techniques. In order to define the extraosseous and intraosseous arterial anatomy in this region, ten specimens were sequentially subjected to injection with Batson's compound, soft-tissue digestion, and bone-clearing according to a modified Spalteholz technique. To further characterize the extraosseous vascular anatomy, the other ten specimens were injected with latex and dissected.
RESULTS
We identified a consistent and previously unnamed blood supply to the distal aspect of the tibia, distal aspect of the fibula, cuboid, and cuneiforms. Four vessels, each present in all of our specimens, provided distinct vascular territories to bone. A branch of the proximal lateral tarsal artery supplied a consistent vascular territory in the cuboid with an average of fifteen nutrient vessels. Similarly, a branch of the distal medial tarsal artery to the first cuneiform supplied an average of nine nutrient vessels superior to the tibialis anterior tendon insertion. A branch of the anterior lateral malleolar artery to the fibula supplied an average of seven nutrient vessels to the lateral malleolus. A branch of the distal lateral tarsal artery provided the midsection of the third cuneiform with an average of seven nutrient vessels. In the latex-injected specimens, harvesting of the vascularized pedicle bone grafts designed from these data demonstrated their anatomic plausibility and arcs of rotation.
CONCLUSIONS
Four new rotational vascularized pedicle bone grafts have been identified in the foot and ankle. These grafts were present in all of our specimens, were well vascularized, had wide arcs of rotation, and were relatively easy to harvest.