Boraiah S, Dyke J P, Hettrich C, Parker R J, Miller A, Helfet D, Lorich D
Hospital for Special Surgery, New York, United States.
J Bone Joint Surg Br. 2009 Jan;91(1):131-7. doi: 10.1302/0301-620X.91B1.21275.
In spite of extensive accounts describing the blood supply to the femoral head, the prediction of avascular necrosis is elusive. Current opinion emphasises the contributions of the superior retinacular artery but may not explain the clinical outcome in many situations, including intramedullary nailing of the femur and resurfacing of the hip. We considered that significant additional contribution to the vascularity of the femoral head may exist. A total of 14 fresh-frozen hips were dissected and the medial circumflex femoral artery was cannulated in the femoral triangle. On the test side, this vessel was ligated, with the femoral head receiving its blood supply from the inferior vincular artery alone. Gadolinium contrast-enhanced MRI was then performed simultaneously on both control and test specimens. Polyurethane was injected, and gross dissection of the specimens was performed to confirm the extraosseous anatomy and the injection of contrast. The inferior vincular artery was found in every specimen and had a significant contribution to the vascularity of the femoral head. The head was divided into four quadrants: medial (0), superior (1), lateral (2) and inferior (3). In our study specimens the inferior vincular artery contributed a mean of 56% (25% to 90%) of blood flow in quadrant 0, 34% (14% to 80%) of quadrant 1, 37% (18% to 48%) of quadrant 2 and 68% (20% to 98%) in quadrant 3. Extensive intra-osseous anastomoses existed between the superior retinacular arteries, the inferior vincular artery and the subfoveal plexus.
尽管已有大量关于股骨头血液供应的描述，但缺血性坏死的预测仍难以捉摸。目前的观点强调了上支持带动脉的作用，但在许多情况下，包括股骨的髓内钉固定和髋关节表面置换，可能无法解释临床结果。我们认为可能存在对股骨头血供有显著额外贡献的血管。共解剖了14个新鲜冷冻的髋关节，并在股三角处对旋股内侧动脉进行插管。在测试侧，结扎该血管，使股骨头仅接受来自下支持带动脉的血液供应。然后对对照标本和测试标本同时进行钆对比增强MRI检查。注入聚氨酯后，对标本进行大体解剖，以确认骨外解剖结构和造影剂的注入情况。在每个标本中均发现了下支持带动脉，其对股骨头血供有显著贡献。将股骨头分为四个象限：内侧（0）、上方（1）、外侧（2）和下方（3）。在我们的研究标本中，下支持带动脉在0象限的血流贡献平均为56%（25%至90%），在1象限为34%（14%至80%），在2象限为37%（18%至48%），在3象限为68%（20%至98%）。上支持带动脉、下支持带动脉和凹下丛之间存在广泛的骨内吻合。
