[Anatomy of pisiform blood supply and feasibility of vascularized pisiform transfer for avascular necrosis of lunate based on digital technique].

To provide anatomical basis for vascularized pisiform transfer in the treatment of advanced avascular necrosis of the lunate (Kienböck's disease) by studying its morphology and blood supply pattern based on digital technique. Twelve adult fresh wrist joint specimens were selected and treated with gelatin-lead oxide solution from ulnar or radial artery. Then the three-dimensional (3D) images of the pisiform and lunate were reconstructed by micro-CT scanning and Mimics software. The morphologies of pisiform and lunate were observed and the longitudinal diameter, transverse diameter, and thickness of pisiform and lunate were measured. The main blood supply sources of pisiform were observed. The number, diameter, and distribution of nutrient foramina at proximal, distal, radial, and ulnar sides of pisiform were recorded. The anatomic parameters of the pedicles (branch of trunk of ulnar artery, carpal epithelial branch, descending branch of carpal epithelial branch, recurrent branch of deep palmar branch) were measured, including the outer diameter of pedicle initiation, distance of pedicle from pisiform, and distance of pedicle from lunate. There were significant differences in the longitudinal and transverse diameters between pisiform and lunate ( There are abundant nutrient vessels at the proximal and ulnar sides of pisiform, so excessive stripping of the proximal and ulnar soft tissues should be avoided during the vascularized pisiform transfer. It is feasible to treat advanced Kienböck's disease by pisiform transfer with the carpal epithelial branch of ulnar artery and the descending branch. 采用数字化技术对豌豆骨及其血供进行解剖观测，为临床带蒂豌豆骨移位治疗晚期月骨缺血性坏死（Kienböck 病）提供解剖学依据。. 取 12 具成人新鲜腕关节标本，从尺动脉或桡动脉灌注明胶-氧化铅溶液后，行 Micro-CT 扫描并采用 Mimics 软件三维重建图像。观察豌豆骨及月骨形态，测量二者纵径、横径及厚度；观察豌豆骨周围血供，其近端、远端、桡侧及尺侧滋养孔分布情况，记录滋养孔数量、直径；测量豌豆骨移位时可选择的血管蒂（尺动脉干分支、腕上皮支、腕上皮支降支和掌深支返支）相关解剖参数，包括血管蒂起始处外径及血管蒂至豌豆骨、月骨距离。. 三维测量显示豌豆骨厚度与月骨差异无统计学意义（ 豌豆骨近端及尺侧滋养血管丰富，因此带蒂豌豆骨移位术中游离豌豆骨时应尽量避免过多剥离近端和尺侧软组织；宜选择带尺动脉腕上皮支及其降支蒂的豌豆骨移位治疗晚期 Kienböck 病。.