Washington University School of Medicine, St Louis, Missouri, USA.
Foot Ankle Int. 2013 Jan;34(1):117-23. doi: 10.1177/1071100712460227.
Osteotomies of the fifth metatarsal may disrupt the nutrient artery and result in nonunion. The location of the nutrient artery foramen relative to the location of common osteotomies has not been described. The goal of this study was to describe the vascular supply of the proximal fifth metatarsal, including the artery of origin of the nutrient artery and the location of the nutrient artery foramen.
Fifty-six adult cadaver specimens were amputated below the knee. The anterior tibial, posterior tibial, and peroneal arteries were injected with India ink and Ward's Blue Latex. The specimens were frozen for 48 hours and then thawed to room temperature. The soft tissues were débrided with sodium hypochlorite, and the extraosseous vascularity was recorded. The fifth metatarsal was then removed and the intraosseous vascular anatomy elucidated using a modified Spälteholz technique.
The dorsalis pedis, posterior tibial, and peroneal arteries branch in predictable patterns to supply the fifth metatarsal. The nutrient artery arose from the fourth plantar metatarsal artery in 100% of specimens and inserted into the plantar medial diaphysis in 83% of specimens. The nutrient artery foramen was an average of 26.8 mm (range, 19-40) from the medial aspect of the base of the fifth metatarsal.
When an operative approach to the fifth metatarsal is planned, care should be taken to avoid stripping the bone on the plantar and medial aspects.
Osteotomies placed within the proximal 40 mm of the bone carry a risk of disrupting the nutrient artery, resulting in possible nonunion.
第五跖骨截骨术可能会破坏营养动脉，导致骨不连。营养动脉孔相对于常见截骨术的位置尚未描述。本研究的目的是描述第五跖骨近端的血管供应，包括营养动脉的起源动脉和营养动脉孔的位置。
56 例成人尸体标本在膝关节以下截肢。用印度墨汁和沃德蓝乳胶注射胫前动脉、胫后动脉和腓动脉。标本冷冻 48 小时，然后解冻至室温。用次氯酸钠去除软组织，记录骨外血管。然后取出第五跖骨，用改良的 Spälteholz 技术阐明骨内血管解剖结构。
足背动脉、胫后动脉和腓动脉以可预测的模式分支，为第五跖骨提供营养。营养动脉 100%发自第四跖底动脉，83%插入跖骨内侧骨干。营养动脉孔距第五跖骨基底内侧面的平均距离为 26.8 毫米（范围，19-40）。
当计划对第五跖骨进行手术入路时，应注意避免在跖侧和内侧剥离骨。
位于骨近端 40 毫米内的截骨术有破坏营养动脉的风险，可能导致骨不连。
