Sussmann Patrick S, Ranawat Anil S, Shehaan Michael, Lorich Dean, Padgett Douglas E, Kelly Bryan T
Hospital for Special Surgery, New York, New York, USA.
Arthroscopy. 2007 Jul;23(7):738-43. doi: 10.1016/j.arthro.2007.01.025.
The goal of this study was to evaluate the risk of vascular injury with arthroscopic osteoplasty of the femoral head-neck junction in a cadaveric model.
Eight fresh-frozen cadaveric pelvi were used for arthroscopic osteoplasty of a predetermined 150 degrees arc of resection along the anterior femoral head-neck junction. Postoperatively, injection studies of the deep femoral arteries were performed on all specimens to identify local extravasation of neoprene latex before polymerization as a reproducible indicator of vascular injury. Control specimens included 1 specimen without an osteoplasty and 1 specimen after an "aggressive" open osteoplasty with intention to violate the superior retinacular vessels.
The first control specimen showed complete filling of the superior retinacula branches, whereas the second control specimen had evidence of intracapsular latex extravasation. In 7 of 8 experimental specimens, there was near-to-complete filling of the superior and inferior retinacula branches with no signs of latex extravasation. In 1 specimen, no superior retinacular branches were identified; however, no extravasation of the latex material was noted. No injury to the main extracapsular branches of the medial or lateral femoral circumflex vessels was noted. We noted on average 3 superior retinacular vessels penetrating the posterior-superior head-neck junction.
There was no evidence of vascular injury to the main blood supply of the femoral head in any of the 8 experimental specimens as noted by latex extravasation. These findings show that arthroscopic osteoplasty can be performed without disrupting the vascular supply to the femoral head.
This article has important information on the relation of vascular structures and the resection limit with arthroscopic osteoplasty of the femoral head-neck junction.
本研究的目的是在尸体模型中评估股骨头-颈交界处关节镜下骨成形术导致血管损伤的风险。
使用8个新鲜冷冻的尸体骨盆进行关节镜下骨成形术，沿着股骨头-颈交界处的前侧进行预定的150度弧形切除。术后，对所有标本进行股深动脉注射研究，以确定在氯丁橡胶乳胶聚合前的局部外渗情况，作为血管损伤的可重复指标。对照标本包括1个未进行骨成形术的标本和1个进行了“激进”开放性骨成形术以有意侵犯上支持带血管的标本。
第一个对照标本显示上支持带分支完全充盈，而第二个对照标本有囊内乳胶外渗的证据。在8个实验标本中的7个中，上、下支持带分支几乎完全充盈，没有乳胶外渗的迹象。在1个标本中，未发现上支持带分支；然而，未观察到乳胶材料外渗。未发现股内侧或外侧旋股血管的主要囊外分支有损伤。我们平均观察到3条上支持带血管穿透后上方的头-颈交界处。
如乳胶外渗所示，8个实验标本中均未发现股骨头主要血供有血管损伤的证据。这些发现表明，关节镜下骨成形术可以在不破坏股骨头血供的情况下进行。
本文提供了关于血管结构与股骨头-颈交界处关节镜下骨成形术切除限度之间关系的重要信息。
