Binns M, Pho R
University Department of Orthopaedic Surgery, National University of Singapore.
Clin Orthop Relat Res. 1990 Jun(255):168-72.
The mechanism of femoral vein occlusion when the hip joint is dislocated and manipulated during arthroplasty has been studied in fresh anatomic specimens. Flow studies show that moderate degrees of flexion and adduction in association with dislocation obstruct venous flow just distal to the femoral sheath at normal pressures and flow rates. Internal femoral rotation during a posterior approach to the hip causes "scissoring" of the femoral vein between femur and pubic bone. External femoral rotation during an anterior approach does not occlude flow. Injection of Batson's acrylic and neoprene latex showed that obstruction is also due to about 4 cm of shortening caused by proximal migration of the femur after dislocation in association with adduction and flexion. The femoral vein in the unsupported segment distal to the femoral sheath subsequently buckles and kinks. During operative manipulation, intermittent obstruction at this level is therefore likely to cause intermittent venous distension distally. This mechanism depletes the femoral vein of fibrinolytic activity distal to the occlusion and may explain the incidence of deep femoral thrombosis peculiar to this procedure.
在新鲜解剖标本中研究了髋关节置换术中髋关节脱位并进行手法操作时股静脉闭塞的机制。血流研究表明，在正常压力和流速下，与脱位相关的中度屈曲和内收会阻碍股鞘远端的静脉血流。后路髋关节手术中股骨内旋会导致股静脉在股骨和耻骨之间“交叉”。前路手术中股骨外旋不会阻塞血流。注入巴特森丙烯酸酯和氯丁橡胶乳胶显示，梗阻还归因于脱位后股骨近端移位并伴有内收和屈曲导致的约4厘米缩短。股鞘远端无支撑段的股静脉随后会发生弯曲和扭结。因此，在手术操作过程中，该水平的间歇性梗阻很可能导致远端间歇性静脉扩张。这种机制会使闭塞远端的股静脉纤溶活性降低，这可能解释了该手术特有的股深静脉血栓形成的发生率。
