| ObjectiveUsing fresh carpal joint cadaver specimens and gelatin-lead oxide perfusion technique,the blood vessels around and inside the carpal joint and capitate bone are developed to explore the perfusion method of human carpal joint and carpal bone artery.Using the C arm fluoroscopy and Micro-CT to scan each specimen,the data obtained by Mimics software are used to reconstruct the three-dimensional visualization model.The general morphology,vascular distribution characteristics and intraosseous blood supply model of the capitate bone are observed and measured to explore possible mechanisms of avascular necrosis of the capitate bone in daily life,and to provide a anatomical basis for the clinical treatment of Kienbock’s disease.MethodsTwelve fresh isolated human wrist specimens were selected,all specimens were placed under C-arm for fluoroscopy to ensure the requirements of the composite experiment for each specimen,and the general morphology of capitate bones was observed.After fluoroscopy,the corresponding ulnar and radial arteries were dissected and separated,and the gelatin-lead oxide solution was perfused from the marked ulnar or radial arteries in a thermostatic water bath using a constant pressure perfusion device.After standing for 24 hours,all the perfused specimens were scanned under the C-arm and Micro-CT one by one,and the vascular distribution characteristics of the wrist joint and the capitate bone were observed.The obtained analysis data was used to reconstruct a three-dimensional visualization model of the capitate bone and the lunate bone by Mimics 20.0 software.The morphology of the capitate bone and lunate bone,the main blood supply sources around the capitate bone,and the intraosseous vascular characteristics were further observed.The length,width,thickness and the diameter,arc length,and arc height of the proximal articular surface of the capitate bone and lunate bone of each specimen were measured and compared.The approximate number and distribution of nutrient vessels foramina of the capitate bone were recorded and the relevant data were statistically analyzed.Results(1)Before perfusion,the general morphology of the capitate bone was clearly observed through C-arm fluoroscopy.Among them,9 cases were F-shaped capitate bone(account for75%),3 cases were S-shaped capitate bone(account for 25%),and none were V-shaped capitate bone.After perfusion,the vascular distribution of the wrist joint could be roughly observed through C-arm fluoroscopy.The vascular network of the wrist joint was mainly composed of branches of the radial artery,the ulnar artery and the anterior interosseous artery,which were anastomosing with each other through branches of the dorsal palmar arch.(2)Micro-CT tomography could be used to roughly observe the intraosseous vascular characteristics of the capitate bone.The nutrient vessels usually entered the bone from the volar or dorsal side of the distal part of the capitate bone,and then retrograded to the proximal end of the capitate bone.The tomographic images showed that at least one of the main blood vessels in the capitate bone traversed the entire capitate bone,forming small branches of blood vessels that supplied blood to other areas of the capitate bone.(3)According to the Mimics 20.0 software,the three-dimensional stereo images of the blood vessels around the wrist joint were roughly reconstructed.It could be found that the blood supply around the capitate bone came from the palmar and dorsal sides,of which the dorsal blood supply was the main source,while the blood supply of the dorsal capitate bone mainly came from the anterior interosseous artery and its branches of the forearm.(4)Mimics20.0 software was used to reconstruct the three-dimensional stereo images of the capitate bone and the adjacent lunate bone respectively.After measuring the relevant parameters,it was found that the length of the capitate bone was(16.30 ± 0.43)mm,the width was(9.75 ± 0.76)mm,and the thickness was(11.52 ± 0.38)mm and lateral outer diameter of the proximal articular surface was(9.87 ± 0.45)mm,arc length was(14.30 ±0.50)mm,arc height was(5.43 ± 0.31)mm,anteroposterior outer diameter of the proximal articular surface was(9.83 ± 0.75)mm,and arc length was(13.10 ± 0.36)mm,arc height was(5.16 ± 0.21)mm;the length of the lunate bone was(6.80 ± 0.42)mm,the width was(7.90 ± 0.67)mm,the thickness was(11.62 ± 0.53)mm,and lateral outer diameter of theproximal articular surface was(9.47 ± 0.51)mm,arc length was(11.80 ± 0.76)mm,arc height was(4.13 ± 0.31)mm,anteroposterior outer diameter of the proximal articular surface was(11.63 ± 0.55)mm,arc length was(16.43 ± 1.05)mm,and arc height was(5.23± 0.57)mm.There was obvious correlation between the two parameters.(5)Mimics20.0 software was used to reconstruct the three-dimensional image of the blood vessels in the capitate bone,showing that the number of nutrient vessels foramina on the dorsal and palmar sides of the capitate bone was(5.8±3.2)and(4.4±1.8)respectively and there was no significant difference between them(P=0.419).The number of nutrient vessels foramina in the distal and proximal part of the capitate bone was(7.2±2.6)and(3.0±1.6)respectively,and the difference between them was statistically significant(P=0.015).The nutrient vessels foramina on the surface of the capitate bone were mainly concentrated in the middle and outer 1/3 of the surface of the capitate bone,and the entry point of the nourishing blood vessels of the most distal part of the capitate bone was approximately 2.2 mm from the base of the capitate bone.Conclusions(1)Using the gelatin-lead oxide solution to perfuse fresh isolated wrist specimens and the functions of Micro-CT tomography and Mimics software for three-dimensional reconstruction,the general morphology,blood vessel distribution and the intraosseous vascular characteristics of the wrist joint and the capitate bone can be observed clearly.It provides a anatomical basis for clinical and scientific research on the mechanism of wrist joint disease.(2)The source of blood supply for nourishing the capitate bone is relatively rich,which mainly comes from the dorsal side,while the blood supply pattern of proximal capitate bone is similar to that of the scaphoid bone and the lunate bone,mainly based on the distal nutrient vessels retrograde blood supply,which is the main reason that clinical proximal AVN of cephalic bone is more common.(3)After three-dimensional reconstruction of the image based on Mimics software and the three-dimensional measurement of the partial parameters of the capitate bone and adjacent lunate bone,it shows that the capitate bone and the lunate bone is highly related in morphology,and the nutrient vessels foramina on the surface of the capitate bone were mainly concentrated in the middle and outer 1/3 of the surface of the capitate bone,and theentry point of the nourishing blood vessels of the most distal part of the capitate bone was approximately 2.2 mm from the base of the capitate bone.Therefore,the current clinical use of capitate osteotomy to treat early Kienbock disease and capitate bone displacement to treat advanced Kienbock disease is of great feasibility. |
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