Launder W J, Hungerford D S, Jones L H
J Bone Joint Surg Am. 1981 Mar;63(3):442-8.
We have determined the pressure-flow relationships of the canine femoral head during venous tamponade of the hip capsule. Intra-osseous pressures were determined before and after infusion of the joint with saline solution to a pressure of sixty-five centimeters of water. Femoral head blood flow was simultaneously determined by the indicator-dilution technique utilizing isotopically labeled microspheres. In puppies, pressure in the femoral head rose 248 per cent while flow dropped by 60 per cent after inflation of the capsule. In adults, no statistically significant change in either pressure or flow was seen. Thus, in the immature animal, venous tamponade results in increased pressure and decreased blood flow. In the mature animal, venous tamponade does not alter intra-osseous pressures or blood-flow rates due to the intact intramedullary venous drainage of the adult femoral head.
In the immature individual, venous tamponade may well be involved in the development of Legg-Perthes disease. A bout of nonspecific synovitis may elevate intracapsular pressure sufficiently to obstruct venous outflow. This creates an increase in intra-osseous pressure and a decrease in femoral head blood flow. Hemodynamic changes of this magnitude have not been shown to induce Legg-Perthes disease; however, a strong suspicion exists that such alterations may be linked to the disease. In the adult, venous tamponade probably is not involved in the pathogenesis of avascular necrosis. The maintenance of intramedullary venous drainage of the epiphysis into the metaphysis may account for the fact that vascular necrosis of the femoral head rarely develops in adult patients with osteoarthritis or rheumatoid arthritis plus an inflammatory synovitis of the hip.
我们已经确定了髋关节囊静脉填塞期间犬股骨头的压力-流量关系。在向关节内注入生理盐水至65厘米水柱压力之前和之后测定骨内压。利用同位素标记微球的指示剂稀释技术同时测定股骨头血流量。在幼犬中，关节囊充气后股骨头压力上升248%，而血流量下降60%。在成年犬中，压力和流量均未观察到统计学上的显著变化。因此，在未成熟动物中，静脉填塞导致压力升高和血流量降低。在成熟动物中，由于成年股骨头完整的骨髓静脉引流，静脉填塞不会改变骨内压或血流速率。
在未成熟个体中，静脉填塞很可能与Legg-Perthes病的发生有关。一次非特异性滑膜炎可能使关节囊内压力升高到足以阻碍静脉流出的程度。这会导致骨内压升高和股骨头血流量降低。这种程度的血流动力学变化尚未被证明可诱发Legg-Perthes病；然而，人们强烈怀疑这种改变可能与该病有关。在成年人中，静脉填塞可能不参与缺血性坏死的发病机制。骨骺骨髓静脉向干骺端的引流得以维持，这可能解释了在患有骨关节炎或类风湿关节炎以及髋关节炎性滑膜炎的成年患者中，股骨头血管坏死很少发生的原因。
