Kalhor Morteza, Horowitz Kevin, Gharehdaghi Jaber, Beck Martin, Ganz Reinhold
Department of Orthopaedic Surgery, Tehran University of Medical Sciences, Firouzgar Medical Centre, Tehran, Iran.
Hip Int. 2012 May-Jun;22(3):307-12. doi: 10.5301/HIP.2012.9242.
The purpose of this cadaveric study was to clearly define the blood supply to the femoral head to help further reduce the incidence of iatrogenic avascular necrosis (AVN). Thirty-five hips of twenty-eight fresh cadavers were injected with colored silicone. Anterior and posterior dissection was performed to assess the vessels contributing to femoral head vascularity. The medial femoral circumflex artery (MFCA) was found to be the main blood supply to the hip in twenty-nine specimens; the inferior gluteal artery (IGA) was found to be the main blood supply in six. The MFCA consistently provided at least one smaller-calibre inferomedial retinacular artery. The foveal artery provided no significant vascular contribution in any specimen. The quantity and calibre of superior retinacular vessels demonstrated their dominance in head vascularity, although inferior retinacular arteries were consistently present. To reduce the risk of iatrogenic AVN, branches of both the IGA and MFCA traversing the interval between the quadratus femoris and piriformis muscles must be protected during surgery. Since all intracapsular vessels penetrated the capsule near its distal attachment, distal capsulotomy carries a significantly higher risk of AVN than proximal capsulotomy, particularly posterolaterally and inferomedially.
本尸体研究的目的是明确股骨头的血供，以帮助进一步降低医源性缺血性坏死（AVN）的发生率。对28具新鲜尸体的35个髋关节注射了彩色硅胶。进行前后解剖以评估对股骨头血供有贡献的血管。在29个标本中发现旋股内侧动脉（MFCA）是髋关节的主要血供；在6个标本中发现臀下动脉（IGA）是主要血供。MFCA始终提供至少一条较小口径的下内侧支持带动脉。在任何标本中，凹动脉均未提供显著的血管贡献。上支持带血管的数量和口径表明它们在股骨头血供中占主导地位，尽管下支持带动脉始终存在。为降低医源性AVN的风险，在手术过程中必须保护IGA和MFCA穿过股方肌和梨状肌之间间隙的分支。由于所有囊内血管均在靠近其远端附着处穿透关节囊，因此远端关节囊切开术导致AVN的风险明显高于近端关节囊切开术，尤其是在后外侧和下内侧。
