保髋手术后发生股骨头缺血坏死的解剖学研究  

An anatomical study of avascular necrosis of the femoral head after hip-salvage operation

作　　者：吴奇[1] 连鹏[2] 汪军[3] 韩一生[1] 

机构地区：[1]第四军医大学西京医院关节外科,西安710032 [2]西安市第四医院影像中心 [3]四川省阆中市人民医院骨科

出　　处：《中国骨与关节杂志》2015年第5期399-403,共5页Chinese Journal of Bone and Joint

摘　　要：目的通过明确股骨头周围血管的解剖研究为预防保髋手术后发生股骨头缺血坏死提供解剖学依据。方法对两具新鲜成人尸体(4髋)进行解剖,明确股骨头周围血管走行的毗邻关系,尤其是旋股内侧动脉深支。并通过对旋股内侧动脉深支注入造影剂进行X线及CT扫描摄片,来观察周围血管对股骨头的血液供应。结果股骨头的血供主要由旋股内、外侧动脉和闭孔动脉的分支供应。其中股骨头绝大部分的血供由旋股内侧动脉深支供应。旋股内侧动脉深支延伸的外侧颈升动脉在股骨头血供中也占了重要作用。通过对注入造影剂的旋股内侧动脉深支完整和其被破坏的股骨头行X线及CT扫描,观察旋股内侧动脉深支对股骨头的血液供应分布。外侧颈升动脉支配股骨头上血供约2/3或3/4,尤其是负重区的血供,在股骨头血供中占据了非常重要的作用;内侧颈升动脉支配股骨头下血供约1/4或1/3,与外侧颈升动脉相比在股骨头血供中相对不太重要;前、后颈升动脉在股骨头血供中所占比例较小;股骨头韧带动脉在股骨头血供中所占比例同样较小,不是主要供血血管。结论本实验通过对股骨头周围血管的解剖研究,明确股骨头主要供血血管走行的毗邻关系,避免损伤旋股内侧动脉深支,防止股骨头缺血坏死,对于指导保髋手术治疗具有重要意义。Objective To provide an anatomical evidence for the prevention of avascular necrosis of the femoral head （ AVN-FH ） after hip-salvage operation through an anatomical study of vascular tissues around the femoral head. Methods Two fresh adult carcasses （ 4 hips ） were dissected to confirm the trend of vessels around the femoral head, especially the deep branch of medial femoral circumflex artery. The femoral head was scanned by CT and X-ray after contrast agents were injected into the deep branch of medial femoral circumflex artery to observe its blood supply. Results The blood supply of the femoral head depends on branches of the medial and lateral femoral circumflex arteries and obturator artery, and mostly depends on the deep branch of medial femoral circumflex artery. The lateral ascending cervical artery extending from the deep branch of medial femoral circumflex artery also plays an important role. The X-ray images and CT scans of the femoral head with contrast agents in the integrated and injured deep branches of medial femoral circumflex artery showed the blood supply distribution in the deep branch of medial femoral circumflex artery. About 2 / 3 or 3 / 4 blood of the femoral head was supplied by the lateral ascending cervical artery, especially that of the weight-bearing area, which occupied a very important role in the blood supply of the femoral head. About 1 / 4 or 1 / 3 blood of the femoral head was supplied by the medial ascending cervical artery, which played a less important role in the blood supply Of the femoral head. A small proportion of blood of the femoral head was supplied by the anterior ascending cervical artery and the posterior ascending cervical artery. The femoral head ligament artery also supplied a small proportion of blood of the femoral head. They were not the main blood vessels. Conclusions Through the anatomical study of vascular tissues around the femoral head, the adjacent relationship of main blood supply arteries of the femoral head is confirmed. The damage to the dee

关 键 词：髋关节 股骨头坏死 解剖学 局部 局部血流 保髋手术 

分 类 号：R687.3[医药卫生—骨科学]