Nötzli H P, Siebenrock K A, Hempfing A, Ramseier L E, Ganz R
Department of Orthopaedic Surgery, University of Zürich, Switzerland.
J Bone Joint Surg Br. 2002 Mar;84(2):300-4. doi: 10.1302/0301-620x.84b2.12146.
We used laser Doppler flowmetry (LDF) with a high energy (20 mW) laser to measure perfusion of the femoral head intraoperatively in 32 hips. The surgical procedure was joint debridement requiring dislocation or subluxation of the hip. The laser probe was placed within the anterosuperior quadrant of the femoral head. Blood flow was monitored in specific positions of the hip before and after dislocation or subluxation. With the femoral head reduced, external rotation, both in extension and flexion, caused a reduction of blood flow. During subluxation or dislocation, it was impaired when the posterosuperior femoral neck was allowed to rest on the posterior acetabular rim. A pulsatile signal returned when the hip was reduced, or was taken out of extreme positions when dislocated. After the final reduction, the signal amplitudes were first slightly lower (12%) compared with the initial value but tended to be restored to the initial levels within 30 minutes. Most of the changes in the signal can be explained by compromise of the extraosseous branches of the medial femoral circumflex artery and are reversible. Our study shows that LDF provides proof for the clinical observation that perfusion of the femoral head is maintained after dislocation if specific surgical precautions are followed.
我们使用高能（20毫瓦）激光的激光多普勒血流仪（LDF）在术中测量了32个髋关节股骨头的灌注情况。手术操作是需要髋关节脱位或半脱位的关节清创术。激光探头置于股骨头的前上象限。在髋关节脱位或半脱位前后，对髋关节的特定位置进行血流监测。当股骨头复位时，无论是伸展还是屈曲时的外旋都会导致血流减少。在半脱位或脱位期间，当股骨颈后上部靠在髋臼后缘时，血流会受到损害。当髋关节复位，或脱位时从极端位置恢复时，会出现搏动信号。最终复位后，信号幅度最初比初始值略低（12%），但在30分钟内趋于恢复到初始水平。信号的大多数变化可由旋股内侧动脉骨外分支受压来解释，且这些变化是可逆的。我们的研究表明，LDF为如下临床观察提供了证据：如果遵循特定的手术预防措施，脱位后股骨头的灌注可得以维持。
