Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
Department of Orthopaedics and Rehabilitation, Vanderbilt University, Nashville, TN.
J Orthop Trauma. 2019 Mar;33(3):111-115. doi: 10.1097/BOT.0000000000001377.
To describe the inferior retinacular artery (IRA) as encountered from an anterior approach, to define its intraarticular position, and to define a safe zone for buttress plate fixation of femoral neck fractures.
Thirty hips (15 fresh cadavers) were dissected through an anterior (Modified Smith-Petersen) approach after common femoral artery injection (India ink, blue latex). The origin of the IRA from the medial femoral circumflex artery and the course to its terminus were dissected. The IRA position relative to the femoral neck was described using a clock-face system: 12:00 cephalad, 3:00 anterior, 6:00 caudad, and 9:00 posterior.
The IRA originated from the medial femoral circumflex artery and traveled within the Weitbrecht ligament in all hips. The IRA positions were 7:00 (n = 13), 7:30 (n = 15), and 8:00 (n = 2). The IRA was 0:30 anterior to (n = 24) or at the same clock-face position (n = 6) as the lesser trochanter. The mean intraarticular length was 20.4 mm (range 11-65, SD 9.1), and the mean extraarticular length was 20.5 mm (range 12-31, SD 5.1).
The intraarticular course of the IRA lies within the Weitbrecht ligament between the femoral neck clock-face positions of 7:00 and 8:00. A medial buttress plate positioned at 6:00 along the femoral neck is anterior to the location of the IRA and does not endanger the blood supply of the femoral head. The improved understanding of the IRA course will facilitate preservation during intraarticular approaches to the femoral neck and head.
描述从前入路观察到的下骺外侧动脉（IRA），确定其关节内位置，并确定股骨颈骨折支撑钢板固定的安全区域。
在股总动脉注射（印度墨汁、蓝色乳胶）后，通过前入路（改良 Smith-Petersen 入路）对 30 髋（15 个新鲜尸体）进行解剖。解剖 IRA 从股内侧旋骺动脉的起源及其到达终末的走行。使用时钟面系统描述 IRA 相对于股骨颈的位置：12:00 为头侧，3:00 为前侧，6:00 为尾侧，9:00 为后侧。
IRA 起源于股内侧旋骺动脉，在所有髋关节中均穿行于 Weitbrecht 韧带内。IRA 的位置分别为 7:00（n = 13）、7:30（n = 15）和 8:00（n = 2）。IRA 比小转子前 0:30（n = 24）或位于同一时钟面位置（n = 6）。IRA 的关节内长度平均为 20.4mm（范围 11-65，SD 9.1），关节外长度平均为 20.5mm（范围 12-31，SD 5.1）。
IRA 的关节内走行位于股骨颈的 7:00 和 8:00 时钟面位置之间的 Weitbrecht 韧带内。沿股骨颈置于 6:00 的内侧支撑钢板位于 IRA 位置的前方，不会危及股骨头的血供。对 IRA 走行的深入了解将有助于在髋关节内入路处理股骨颈和头部时对其进行保护。
