Wavreille G, Dos Remedios C, Chantelot C, Limousin M, Fontaine C
Faculty of Medicine, Institute of Anatomy and Organogenesis, University of Lille2, 59045, Lille Cedex, France.
Surg Radiol Anat. 2006 Oct;28(5):498-510. doi: 10.1007/s00276-006-0130-z. Epub 2006 Jul 13.
In order to later make precise the operative technique of free vascularized elbow allograft transfer, the anatomic conditions necessary for the success of such an operation are reviewed. The exact topography of the nutrient foramina of the humerus, radius, and ulna has been specified on 102 dry bones. The osseous resection at the recipient will have to be carried out on these aspects: nutrient foramina of the three bones of the elbow (at 9 cm from medial epicondyle for the humerus; at 8 cm for the two bones of forearm) in order to preserve diaphysary vascularization of the recipient. A study of arterial and venous vascularization carried out on 18 anatomic specimens showed that the osseous ends were irrigated by a periosteal arterial network and were drained in the centromedullary cavities. Systematization of the arteriovenous blood supply of the distal end of the humerus and proximal ends of the two forearm bones is proposed after dissection of 18 anatomic specimens. Arterial periosteal territories are defined. The importance of each peri articular arteriole is estimated according to the surface of its respective section. A radial, constant, and musculoperiosteal collateral artery from the brachial artery is described. It accounts for 12% (+/- 3%) of the total contribution. The recurrent radial artery is the most significant: 31% (+/- 9%) of the total contribution. The profunda brachii artery is negligible: 4% (+/- 2%) of the total contribution. As well for vascular as mechanical reasons, osteosynthesis will have to be carried out using screwed plates, the optimal location of which is specified according to the arterial periosteal cartography. Ulnar and radial nerves and, to a lesser extent, the median nerve can be harvested "en bloc" preserving their vascular supply in order to make vascularized grafts of them. Free vascularized elbow allograft transfer is technically possible, if one respects these anatomic bases.
为了日后精确阐述带血管游离肘关节异体移植的手术技术，现将此类手术成功所需的解剖学条件进行回顾。已在102块干燥骨上明确了肱骨、桡骨和尺骨滋养孔的确切位置。在受区进行骨切除时，必须考虑以下方面：肘关节三块骨的滋养孔（肱骨在内上髁内侧9厘米处；前臂两块骨在8厘米处），以保留受区骨干的血运。对18个解剖标本进行的动静脉血运研究表明，骨端由骨膜动脉网供血，并通过中央髓腔引流。在解剖18个解剖标本后，提出了肱骨远端及前臂两块骨近端动静脉血供的系统化方法。定义了骨膜动脉区域。根据各关节周围小动脉相应截面的面积估算其重要性。描述了一条来自肱动脉的恒定的桡侧肌骨膜侧支动脉，其供血占总量的12%（±3%）。桡侧返动脉最为重要：供血占总量的31%（±9%）。肱深动脉可忽略不计：供血占总量的4%（±2%）。出于血管和机械方面的原因，必须使用带螺纹的钢板进行骨固定，并根据骨膜动脉分布图确定其最佳位置。尺神经和桡神经，以及程度较轻的正中神经，可以在保留其血供的情况下“整块”获取，以便制作带血管的神经移植体。如果遵循这些解剖学基础，带血管游离肘关节异体移植在技术上是可行的。
