The Curtis National Hand Center, Medstar Union Memorial Hospital, Baltimore, MD; Georgetown University School of Medicine, Washington, DC.
Musculoskeletal Research Center, Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD.
J Hand Surg Am. 2024 Jul;49(7):713.e1-713.e7. doi: 10.1016/j.jhsa.2022.09.014. Epub 2022 Nov 1.
To characterize the periosteal and endosteal arterial perfusion of the proximal phalanx using micro-computed tomography angiography (micro-CTA).
Cadaveric upper extremities were injected with a barium sulfate/gelatin suspension. Phalanges were imaged using micro-CTA and analyzed with a focus on osseous arterial anatomy. Periosteal and endosteal perfusion was characterized by number of vessels, length, anatomic course, and caliber.
The base of the proximal phalanx had a significantly greater number (8.0 ± 3.5) of periosteal vessels than those of the shaft (4.1 ± 1.6) and head (1.3 ± 1.1). One-third (34.4%) of the specimens demonstrated a complete absence of periosteal vessels in the head. A nutrient endosteal vessel was noted in 100% of the specimens. Entering at the junction of the middle and distal third of the bone (25.8 ± 3.9 mm from base), the nutrient vessel entered the proximal phalanx of the index finger along its ulnar aspect (8 of 8 specimens), the middle finger along its radial aspect (6 of 8), the ring finger along its ulnar aspect (5 of 8), and the little finger along its radial aspect (7 of 8). The nutrient vessel branched into proximal and distal extensions toward the shaft and head, respectively, with an average endosteal length of 10.7 ± 5.2 mm and average diameter of 0.36 ± 0.11 mm.
Periosteal contributions to the perfusion of the proximal phalanx appear to diminish distally. The endosteal arterial anatomy remains consistent, with a single nutrient vessel entering the intramedullary canal with reliable laterality on each digit. This is often the only vessel supplying the head of the proximal phalanx, making this area particularly susceptible to vascular compromise.
An understanding of the patterns of perfusion of the proximal phalanx provides some insight into clinically observed pathology, as well as guidance for operative management.
使用微计算机断层血管造影术（micro-CTA）描绘近节指骨的骨膜和骨髓内动脉灌注情况。
将硫酸钡/明胶混悬液注入尸体上肢。使用 micro-CTA 对指骨进行成像，并重点分析骨动脉解剖结构。通过血管数量、长度、解剖路径和口径来描述骨膜和骨髓内的灌注情况。
近节指骨基底的骨膜血管数量明显多于骨干（8.0 ± 3.5 比 4.1 ± 1.6）和头部（1.3 ± 1.1）。三分之一（34.4%）的标本头部完全没有骨膜血管。100%的标本存在营养性骨髓内血管。该血管从骨干中、远三分之一交界处（距基底 25.8 ± 3.9mm）进入近节指骨，进入食指时沿尺侧（8 个标本全部如此），中指时沿桡侧（8 个标本中的 6 个），环指时沿尺侧（8 个标本中的 5 个），小指时沿桡侧（8 个标本中的 7 个）。营养性骨髓内血管分别向骨干和头部分支，形成近侧和远侧延伸，其平均骨髓内长度为 10.7 ± 5.2mm，平均直径为 0.36 ± 0.11mm。
近节指骨的骨膜灌注贡献似乎随著向远端而减少。骨髓内动脉解剖结构保持一致，每个手指都有一条营养性血管进入髓腔，具有可靠的侧位性。这通常是供应近节指骨头部的唯一血管，使该区域特别容易发生血管损伤。
对近节指骨灌注模式的了解为观察到的临床病理提供了一些见解，并为手术管理提供了指导。
