Arnoldi C C, Lemperg R K
Clin Orthop Relat Res. 1977 Nov-Dec(129):217-22.
The opinion is widely held that interruption of the arterial flow through the retinacular arteries to the femoral head is the main cause of avascular necrosis after fracture of the neck. In this study the state of the vascular supply to the femoral head was assessed--prior to osteosynthesis--by means of intramedullary pressure measurements in the femoral head and neck in 72 patients with medial neck fractures. The patients were followed 2 or 3 years or until avascular necrosis became evident. The relative importance of primary avascularity and surgical technique for the development of necrosis suggests that damage to the retinacular arteries may not be the single decisive factor in the pathogenesis of femoral head necrosis. Proper fracture reduction with extensive contact between the cancellous bone surfaces and stable fixation seemed to be more important, probably because they offer the best possibilities for re-establishment of transosseous blood flow across the fracture site.
一种广泛持有的观点认为，通过支持带动脉至股骨头的动脉血流中断是颈部骨折后缺血性坏死的主要原因。在本研究中，对72例内侧颈部骨折患者在进行骨合成术前，通过测量股骨头和颈部的髓内压力来评估股骨头的血管供应状态。对患者进行了2年或3年的随访，或直至缺血性坏死明显出现。原发性缺血和手术技术对坏死发展的相对重要性表明，支持带动脉损伤可能不是股骨头坏死发病机制中的唯一决定性因素。松质骨表面之间广泛接触的适当骨折复位和稳定固定似乎更为重要，可能是因为它们为重建骨折部位的经骨血流提供了最佳可能性。
