Reddy A S, Frederick R W
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Am J Sports Med. 1998 May-Jun;26(3):415-9. doi: 10.1177/03635465980260031201.
Osteonecrosis of the distal femur occurs more often in the medial femoral condyle than in the lateral femoral condyle, but the vascular supply to these regions has not previously been described. Twelve fresh adult cadaver legs were injected with india ink or latex via the femoral artery and then meticulously dissected to evaluate the extraosseous blood supply. After all soft tissue was removed, the intraosseous blood supply was evaluated using a modified Spateholtz technique. The vascular structures at risk during posterior cruciate ligament reconstruction were also identified. The analysis of the extraosseous arterial supply demonstrated that the superior and inferior lateral genicular arteries combine to supply the lateral femoral condyle. The medial femoral condyle is supplied primarily by the superior medial genicular artery and other lesser branches of the popliteal artery. The intraosseous supply to the lateral condyle was shown to consist of an arcade of vessels providing multiple branches to the subchondral bone with no obvious "watershed" region of limited vascularity. The intraosseous supply to the medial condyle appeared to consist of a single nutrient vessel supplying the subchondral bone with an apparent watershed area of limited supply. A potentially significant difference exists between the intraosseous and extraosseous blood supply to the medial and lateral femoral condyles that may explain the higher frequency of ischemic events occurring in the medial femoral condyle. The close proximity of the extraosseous vessels to the medial femoral condyle and the standard femoral tunnel used during posterior cruciate ligament reconstruction may explain the occurrence of avascular necrosis after this procedure.
股骨远端骨坏死在内侧股骨髁比外侧股骨髁更常见，但此前尚未描述过这些区域的血管供应情况。对12条新鲜成人尸体下肢经股动脉注入印度墨水或乳胶，然后仔细解剖以评估骨外血液供应。去除所有软组织后，采用改良的斯帕特尔茨技术评估骨内血液供应。还确定了后交叉韧带重建过程中存在风险的血管结构。对骨外动脉供应的分析表明，膝上外侧动脉和膝下外侧动脉联合供应外侧股骨髁。内侧股骨髁主要由膝上内侧动脉和腘动脉的其他较小分支供应。外侧髁的骨内供应显示为由血管弓组成，为软骨下骨提供多个分支，没有明显的血管供应受限的“分水岭”区域。内侧髁的骨内供应似乎由一条单一的滋养血管组成，为软骨下骨供血，有一个明显的供血受限的分水岭区域。股骨内侧髁和外侧髁的骨内和骨外血液供应之间存在潜在的显著差异，这可能解释了内侧股骨髁缺血事件发生率较高的原因。骨外血管与内侧股骨髁的紧密接近以及后交叉韧带重建过程中使用的标准股骨隧道可能解释了该手术后无血管性坏死的发生。
