Kraus Jonathan C, McKeon Kathleen E, Johnson Jeffrey E, McCormick Jeremy J, Klein Sandra E
Orthopedic Institute of Wisconsin, Milwaukee, WI, USA.
Foot Ankle Int. 2014 Apr;35(4):394-400. doi: 10.1177/1071100713518505. Epub 2013 Dec 27.
Osteotomies of the medial cuneiform are commonly used to correct forefoot deformity. Bone healing occurs despite periosteal stripping of the dorsal and medial surfaces of this widely articulated bone followed by osteotomy in the midsection of the bone. The objective of this study was to characterize the blood supply of the medial cuneiform.
Thirty matched pairs of adult cadaver legs, 60 legs total, were amputated below the knee, and arterial casts were created with India ink and latex. Soft tissues were debrided, allowing visualization of the extraosseous blood vessels. In 53 specimens the vascular supply to the medial cuneiform was photographed and recorded. Forty-nine specimens were then cleared using a modified Spälteholz technique. The intraosseous vascularity of the medial cuneiform was successfully characterized and reviewed in 48 of these specimens.
The extraosseous blood supply was similar to previous reports with a middle pedicle branch originating from the dorsalis pedis artery. The medial plantar and superficial medial plantar artery supplied the plantar aspect of the bone. Intraosseous analysis showed a dense capillary network throughout the cuneiform, with typically one central medial major and several minor nutrient arteries noted. Areas of hypovascularity were infrequent and when noted occurred at inconsistent locations.
These findings support the clinical suspicion that the medial cuneiform is well vascularized from multiple sources. The plantar blood supply is likely sufficient to allow bone healing after dorsal periosteal exposure and possible injury to the middle pedicle branch of the distal medial tarsal artery.
A medial cuneiform opening wedge osteotomy can be used to correct forefoot deformity. This study investigates the blood supply to that bone to better characterize the healing potential of the medial cuneiform.
内侧楔骨截骨术常用于矫正前足畸形。尽管对这块广泛关节化的骨头的背侧和内侧表面进行了骨膜剥离，随后在骨头中部进行了截骨术，但仍会发生骨愈合。本研究的目的是描述内侧楔骨的血供情况。
共30对成年尸体下肢（共60条腿）在膝关节以下截肢，用印度墨水和乳胶制作动脉铸型。清除软组织，以便观察骨外血管。对53个标本中内侧楔骨的血管供应进行拍照和记录。然后对49个标本采用改良的施帕尔茨技术进行清理。其中48个标本成功地描述并观察了内侧楔骨的骨内血管情况。
骨外血供与先前报道相似，有一个中间蒂分支起源于足背动脉。足底内侧动脉和足底内侧浅动脉供应骨头的足底部分。骨内分析显示整个楔骨有密集的毛细血管网，通常可见一条中央内侧主要营养动脉和几条次要营养动脉。血管减少区域不常见，且出现位置不一致。
这些发现支持了临床怀疑，即内侧楔骨有来自多个来源的丰富血供。足底血供可能足以使骨在背侧骨膜暴露及可能损伤跗骨内侧远端动脉中间蒂分支后实现愈合。
内侧楔骨开放楔形截骨术可用于矫正前足畸形。本研究调查了该骨头的血供情况，以更好地描述内侧楔骨的愈合潜力。
