Outerbridge R E
Clin Orthop Relat Res. 1978 Nov-Dec(137):132-9.
Although perosseous venography of the hip is simple, variations in the circulation of the femoral head and difficulties in prediction of viability account for its limited acceptance. The venogram accurately demonstrates viability in 77% of 50 routinely fixed subcapital fractures. Factors causing variations in the circulation of the fractured head are: method of surgical fixation; efficiency of the fixation, and the clinical course of healing. These and other less obvious factors make it impossible to correctly interpret a venogram. Because of a 3 week delay before cell death becomes apparent, a histological examination of a further 20 femoral heads excised after venography is equally unsatisfactory. In 50 fractures labelled with tetracycline preoperatively, subjected to venography, and then treated by hemiarthroplasty, the level of tetracycline fluorescence by the osteocytes can be correlated with the venogram predictions. There is a 92% correlation of venography with tetracycline evaluations of head viability. Venography can distinguish the dead femoral heads from those with potential or adequate vascularity and thereby provide essential clinical information for the operating surgeon.
尽管髋关节骨内静脉造影术操作简单，但股骨头血循环的变异以及预测股骨头存活情况的困难导致其应用受限。在50例常规固定的股骨头下骨折中，静脉造影能准确显示77%的骨折股骨头的存活情况。导致骨折股骨头血循环变异的因素有：手术固定方法；固定的有效性以及愈合的临床过程。这些因素以及其他不太明显的因素使得难以正确解读静脉造影结果。由于细胞死亡在3周后才明显显现，因此对另外20例静脉造影后切除的股骨头进行组织学检查同样不尽人意。在50例术前用四环素标记、进行静脉造影然后行半关节置换术的骨折病例中，骨细胞的四环素荧光水平可与静脉造影预测结果相关联。静脉造影与四环素评估股骨头存活情况的相关性为92%。静脉造影能够区分坏死的股骨头与具有潜在或充足血供的股骨头，从而为手术医生提供重要的临床信息。
