Wu Shenghui, Quan Kun, Wang Wei, Zhang Yingqi, Mei Jiong
Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Jiangxi, China.
Front Surg. 2022 Apr 28;9:852653. doi: 10.3389/fsurg.2022.852653. eCollection 2022.
A detailed depiction of nutrient foramina is useful for defining guidelines and minimising iatrogenic damage during hip surgery. Therefore, this study aimed to define the location and frequency of nutrient foramina in the proximal femur using mapping techniques.
One hundred dry human cadaveric proximal femurs, comprising 56 left and 44 right femurs, were scanned using a three-dimensional scanner, with scanning distance 200 mm, precision 0.01 mm, and measuring point 0.04 mm. The image resolution of 1,310,000 pixels was obtained. Digital imaging models were acquired from the proximal femur surface. All the nutrient foramina in each model were identified and marked. The nutrient foramina models were superimposed on one another and oriented to fit a standard template of the femur's proximal aspect. Three-dimensional mapping in the proximal femur's nutrient foramina was performed.
The nutrient foramina's location and dense zones were identified. The dense zones were distributed along the vascular course and gaps between the muscle attachment sites. Eighteen dense zones were identified and found to be location-dependent. They were located in the central part of the fovea capitis femoris, subcapital and basicervical areas of the femoral neck, and muscle attachment gaps of the femoral trochanter.
The terminal branch of the nutrient vessels entering the nutrient foramina is at risk for iatrogenic damage during hip surgeries, especially in cases of close bone exposures. There are 18 dense zones that need to be considered for a safer approach to the proximal femur. To minimise iatrogenic damage to the nutrient vessels entering the nutrient foramina, the dense areas should be avoided when technically possible.
详细描述营养孔有助于制定髋关节手术指南并将医源性损伤降至最低。因此,本研究旨在使用映射技术确定股骨近端营养孔的位置和频率。
使用三维扫描仪对100具干燥的人类尸体股骨近端进行扫描,其中包括56根左侧股骨和44根右侧股骨,扫描距离为200毫米,精度为0.01毫米,测量点为0.04毫米。获得了1310000像素的图像分辨率。从股骨近端表面获取数字成像模型。识别并标记每个模型中的所有营养孔。将营养孔模型相互叠加并定向以匹配股骨近端的标准模板。对股骨近端营养孔进行三维映射。
确定了营养孔的位置和密集区域。密集区域沿血管走行和肌肉附着部位之间的间隙分布。识别出18个密集区域,发现其与位置有关。它们位于股骨头凹的中央部分、股骨颈的头下和基底颈区域以及股骨转子的肌肉附着间隙处。
进入营养孔的营养血管终末分支在髋关节手术中存在医源性损伤风险,尤其是在骨暴露接近的情况下。有18个密集区域在处理股骨近端时需要考虑以采取更安全的方法。为尽量减少对进入营养孔的营养血管的医源性损伤,在技术可行时应避免这些密集区域。