Table_1_Vascular supply of the metacarpophalangeal joint.docx

ObjectiveTo describe in detail the arterial vasculature of metacarpophalangeal joints 2–5 on cadaver specimens and to compare it to ultrasound imaging of healthy subjects.
MethodsEighteen hands of donated human cadavers were arterially injected and investigated with either corrosion casting or cryosectioning. Each layer of cryosectioned specimens was photographed in high-resolution. Images were then segmented for arterial vessels of the metacarpophalangeal (MCP) joints 2–5. The arterial pattern of the joints was reconstructed from the segmented images and from the corrosion cast specimens. Both hands of ten adult healthy volunteers were scanned focusing on the vasculature of the same joints with high-end ultrasound imaging, including color Doppler. Measurements were made on both cryosectioned arteries and Doppler images.
ResultsThe arterial supply of MCP joints 2–5 divides into a metacarpal and a phalangeal territory, respectively. The metacarpal half receives arteries from the palmar metacarpal arteries or proper palmar digital arteries, while the phalangeal half is supplied by both proper and common palmar digital arteries. Comparing anatomical and ultrasonographic results, we determined the exact anatomic location of normal vessels using Doppler images acquired of healthy joints. All, except three branches, were found with less than 50% frequency using ultrasound. Doppler signals were identified significantly more frequently in MCP joints 2–3 than on 4–5 (p < 0.0001). Similarly, Doppler signals differed in the number of detectable small, intraarticular vessels (p < 0.009), but not that of the large extraarticular ones (p < 0.1373). When comparing measurements acquired by ultrasound and on cadaver vessels, measurements using the former technique were found to be larger in all joints (p < 0.0001).
ConclusionUsing morphological and ultrasonographic techniques, our study provides a high-resolution anatomical maps and an essential reference data set on the entire arterial vasculature of healthy human MCP 2–5 joints. We found that Doppler signal could be detected in less than 50% of the vessels of healthy volunteers except three locations. Intraarticular branches were detected with ultrasound imaging significantly more frequently on healthy MCP 2–3 joints, which should be taken into account when inflammatory and normal Doppler signals are evaluated. Our study also provides reference data for future, higher-resolution imaging techniques.

研究目的：详细描述2~5掌指关节（metacarpophalangeal joints, MCP）的动脉血管解剖结构，并将其与健康受试者的超声成像结果进行对比。
研究方法：本研究对18具捐献的人类尸体手部进行动脉灌注，分别采用腐蚀铸型（corrosion casting）或冷冻切片（cryosectioning）技术开展研究。对冷冻切片标本的每一层进行高分辨率拍摄，随后对2~5掌指关节的动脉血管进行图像分割。从分割后的图像及腐蚀铸型标本中重建该类关节的动脉构型。招募10名健康成年志愿者，对其双手采用高端超声成像（含彩色多普勒color Doppler）扫描，重点观察上述关节的血管分布情况。分别对冷冻切片动脉标本及多普勒图像进行测量。
研究结果：2~5掌指关节的动脉供血可分别划分为掌侧区域与指骨区域。掌侧区域的血供源自掌掌动脉或指掌固有动脉，而指骨区域则同时接受指掌固有动脉与指掌总动脉的供血。对比解剖学与超声影像学结果，本研究通过健康关节的多普勒图像确定了正常血管的精确解剖位置。除3支血管外，其余血管在超声下的检出率均低于50%。2~3掌指关节的多普勒信号检出率显著高于4~5掌指关节（p < 0.0001）。同样，可检测到的关节内细小血管数量存在显著差异（p < 0.009），但关节外大血管的检出数量无显著差异（p = 0.1373）。对比超声与尸体标本的测量结果，超声测量的所有关节相关数据均大于尸体标本测量值（p < 0.0001）。
研究结论：本研究通过形态学与超声影像学技术，构建了健康人类2~5掌指关节完整动脉血管系统的高分辨率解剖图谱，并提供了关键参考数据集。我们发现，除3个解剖位置外，健康志愿者体内其余血管的多普勒信号检出率均低于50%。超声成像对健康2~3掌指关节的关节内分支检出率显著更高，这一点在评估炎症性与正常多普勒信号时需予以考虑。本研究同时为未来更高分辨率成像技术的发展提供了参考数据。