Wang Hongyu, Wang Dingsong, Wan Jiaming, Wang Xiaosong, Hou Ruixing
Suzhou Medical College of Soochow University, Suzhou, China.
Yangzhou University Medical College, Yangzhou, China.
Heliyon. 2024 Feb 3;10(3):e25555. doi: 10.1016/j.heliyon.2024.e25555. eCollection 2024 Feb 15.
The reconstruction of femoral head blood supply is crucial in the management of avascular necrosis and related conditions. This study presents a method for reconstructing the femoral head blood supply by anastomosing the intraosseous artery.
The femoral heads of six male Landrace swine were surgically exposed, and subcranial fractures of the femoral neck were intentionally created. Under microscopic guidance, the trophoblastic foramen of the posterior supporting artery was identified. Subsequently, a triangular bone window was carefully crafted to expose the intraosseous artery. Following the fixation of the femoral head, an anastomosis was performed between the intraosseous artery and the posterior inferior supporting artery located at the distal end of the fracture. The assessment of femoral head blood supply was conducted using Kirschner's pinhole and angiography techniques.
The anastomotic intraosseous artery exhibited a vibrant red color, indicating adequate blood perfusion, and demonstrated pulsatile flow. Observation through pinholes in the surface of the femoral head revealed continuous blood flow. Angiography further confirmed the successful circulation, as the contrast agent entered the inferior retinacular artery branch originating from the deep femoral artery. The contrast agent then proceeded to enter the femoral head through the retinacular artery, reaching the anastomosis site of the intraosseous artery. Notably, the angiography also revealed the presence of visible internal branches, highlighting the establishment of a functional vascular network.
The method of reconstructing the blood supply to the femoral head through anastomosis of the intraosseous artery enables utilization of the existing blood supply system within the femoral head. This study is just a preliminary study of this innovative technique that has the potential to prevent and/or treat femoral head necrosis following a femoral neck fracture. By restoring adequate blood flow to the affected area, this approach holds promise in preserving the viability and functionality of the femoral head, ultimately improving patient outcomes.
股骨头血供重建在缺血性坏死及相关病症的治疗中至关重要。本研究提出一种通过吻合骨内动脉重建股骨头血供的方法。
手术暴露6只雄性长白猪的股骨头，故意制造股骨颈头下型骨折。在显微镜引导下，识别后支持动脉的滋养孔。随后，精心制作一个三角形骨窗以暴露骨内动脉。固定股骨头后，在骨内动脉与位于骨折远端的后下支持动脉之间进行吻合。使用克氏针孔法和血管造影技术评估股骨头血供。
吻合后的骨内动脉呈现鲜艳的红色，表明血液灌注充足，并显示出搏动性血流。通过股骨头表面的针孔观察发现血流持续。血管造影进一步证实循环成功，因为造影剂进入了发自股深动脉的下支持带动脉分支。造影剂随后通过支持带动脉进入股骨头，到达骨内动脉的吻合部位。值得注意的是，血管造影还显示存在可见的内部分支，突出了功能性血管网络的建立。
通过吻合骨内动脉重建股骨头血供的方法能够利用股骨头内现有的血供系统。本研究只是对这种创新技术的初步研究，该技术有潜力预防和/或治疗股骨颈骨折后的股骨头坏死。通过恢复受影响区域的充足血流，这种方法有望保留股骨头的活力和功能，最终改善患者预后。
