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背景:膝关节半月板损伤缝合的半月板能否修复愈合,血液供给(简称血供)是根本。1982年Arnoczky将半月板组织按照血供情况划分为3个区:距半月板-滑膜结合部3mm以内者为绝对有血管区称为红区;相距5mm以上者为绝对无血管区称为白区;相距3～5mm者为相对有血管区称为红-白区。目的:观察半月板血供解剖学特征,探讨其血液供应特点。设计:单一样本观察。单位:四川大学华西医院骨科。对象:实验于2000-09/2001-03在四川大学华西医院完成。收集标本19例19膝(38侧半月板),男17例,女2例;年龄2l～43岁。均为手术截肢,意外事故离断肢体无再植条件,患者自愿捐献,来源于四川地区生活的非少数民族人群。方法:①半月板透明标本的血供观察:取7膝(14侧)关节经股动脉插管,肝素生理盐水灌注血管床无血后,用体积分数为0.5的墨汁生理盐水灌注,灌注压力13kPa。灌注后的半月板标本经梯度乙醇脱水、二甲苯透明、冬青油保存后在手术显微镜下观察和描述半月板血供分布。②半月板组织切片血管分布观察:取6膝(12侧)新鲜非灌注半月板标本,分别进行矢状位,冠状位及水平位切片,苏木精-伊红染色;另取6膝(12侧),进行特异性的CD34抗体免疫组织化学染色,在光学显微镜下观察半月板的组织结构及血供分布。主要观察指标:①半月板血供来源。②半月板体部血供特征。③半月板角部血供特征。④半月板无血供区的营养供应。结果:19例38侧半月板均进入结果分析。①半月板血供来源:来源于膝内、外侧及膝中动脉等的小血管在滑膜及关节囊组织中形成半月板周围毛细血管丛及环状血管网进入半月板,供养半月板的外侧缘。②半月板体部的血供:半月板周围的血管丛发出的入板小动脉进入体部后,一般排列为上、中、下3层,支配半月板周边25%～30%的区域。③半月板角部的血供:半月板角部的血管分布于角的整个区域。④半月板无血管区的营养供应:体部内侧65%～70%的区域及半月板表面无血管分布,其表面平行分布一层膜状滑液层,由滑液提供营养。结论:①获得与Arnoczky半月板″红白分区法″相一致的半月板血供结论。②发现半月板前后角部及其周围组织血管血供丰富的特点。③新提出半月板体部的血管血供呈分层现象的特征。④明确半月板无血管区营养靠关节滑液供应的证据。
BACKGROUND: Knee meniscus injury can repair the healing of sutured meniscus. Blood supply (referred to as blood supply) is fundamental. In 1982 Arnoczky the meniscal tissue according to the blood supply is divided into three areas: from the meniscus - synovial junction within 3mm absolute vascular area known as the red zone; more than 5mm away from the absolute no vascular area is called white District; 3 ~ 5mm apart from the relative vascular area known as red - white area. Objective: To observe the anatomic characteristics of meniscus blood supply and explore its blood supply characteristics. Design: Single sample observation. Unit: West China Hospital of Sichuan University, Department of Orthopedics. Subjects: Experiments were performed at West China Hospital of Sichuan University from September 2000 to March 2001. Nineteen cases (19 menisci) were collected from 19 patients, including 17 males and 2 females. The age ranged from 21 to 43 years old. Surgical amputation, accidental amputation limb no replantation conditions, voluntary donation of patients, from non-ethnic minority groups living in Sichuan. Methods: ① blood supply of meniscal clear specimens: take 7 knees (14 side) joint femoral artery catheterization, heparin saline perfusion vascular bed without blood, the volume fraction of 0.5 ink saline perfusion, perfusion pressure 13kPa . After perfusion of the meniscus samples by gradient ethanol dehydration, xylene transparent, preserved winter oil observed and described under a surgical microscope blood distribution of the meniscus. (2) Observation of the blood vessel distribution of the meniscus tissue section: Fresh non-perfusion meniscus specimens were obtained from 6 knees (12 sides), and sagittal and eosin were stained by sagittal, coronal and horizontal sections respectively. Side), specific CD34 antibody immunohistochemical staining, observed under a light microscope meniscus tissue structure and blood distribution. MAIN OUTCOME MEASURES: ① meniscus blood supply. ② meniscus blood supply characteristics of the body. ③ meniscus corner of the blood supply characteristics. ④ meniscal supply of nutrients for the area. Results: Nineteen patients with 38 menisci entered the result analysis. ① blood supply from the meniscus: derived from the knee, lateral and middle of the knee and other small blood vessels in the synovium and joint capsule tissue around the meniscus capillary network and the annular blood vessels into the meniscus, supporting the lateral meniscus edge. ② blood supply of the meniscus body: the blood vessels around the meniscus into the platelet arteries into the body, the general arrangement for the upper, middle and lower 3 layers, dominate the meniscus around 25% to 30% of the area. ③ blood supply at the meniscus corner: blood vessels at the corner of the meniscus are distributed over the entire area of the corner. ④ meniscal nutrient area supply: 65% to 70% of the inner body area and the meniscus area without vascular distribution, the surface parallel to the distribution of a layer of synovial layer of synovial fluid, by the synovial fluid to provide nutrition. Conclusions: ① Obtain the conclusion of meniscus blood supply consistent with Arnoczky meniscus “red and white partitioning method”. ② Found around the corner of the meniscus and its surrounding tissue blood supply rich features. ③ new proposed meniscus vascular blood supply for stratification of the characteristics of the phenomenon. Â ’£ clear meniscal non-vascular nutrient supply by joint synovial evidence.