Kirschner M H, Menck J, Hennerbichler A, Gaber O, Hofmann G O
Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Germany.
World J Surg. 1998 Aug;22(8):845-51; discussion 852. doi: 10.1007/s002689900480.
The role of the periosteal and intraosseous blood supply to the femur and the proximal tibia was investigated to improve the operating technique for transplantation of allogenic vascularized femoral diaphyses and knee joints in humans. Altogether 48 limbs were injected with gelatin, red latex milk, or Revertex and macroscopically prepared; 41 limbs were studied for the variation and division of the truncus profundo-circumflexus. In 200 femurs and 200 tibias the location of the nutrient foramen was determined. The arteries supplying the periosteum of the distal femur and the proximal tibia have defined nutritive areas. The following technique should be followed: If the femoral artery alone is prepared as the vascular pedicle, the optimal section for resection of the femur in knee joint transplantations is 6 to 12 cm above the level of the femur condyles and 5 to 7 cm below the tibial plateau. For the transplantation of femoral diaphyses, the deep femoral artery can be used if the lateral femoral circumflex artery is protected. The Proximal line of resection is defined between the greater and lesser trochanter. For shorter grafts one must consider the number and location of nutrient foramens. For longer grafts the distal branches of the femoral artery must be respected as the intraosseous blood supply reaches distally down to the level of about 8 cm above the femoral condyles. In all these operations of the variation of the truncus profundo-circumflexus and the trifurcation of the popliteal artery must be considered.
为改进人同种异体带血管股骨骨干和膝关节移植的手术技术,对股骨和胫骨近端的骨膜及骨内血供作用进行了研究。共对48条肢体注射明胶、红色乳胶乳剂或聚乙烯醇,并进行宏观制备;对41条肢体研究了旋股深动脉干的变异和分支情况。在200根股骨和200根胫骨中确定了滋养孔的位置。供应股骨远端和胫骨近端骨膜的动脉有明确的营养区域。应遵循以下技术:若仅将股动脉作为血管蒂制备,膝关节移植中股骨切除的最佳部位是在股骨髁水平上方6至12厘米及胫骨平台下方5至7厘米处。对于股骨骨干移植,若旋股外侧动脉得到保护,可使用股深动脉。切除的近端线界定在大转子和小转子之间。对于较短的移植物,必须考虑滋养孔的数量和位置。对于较长的移植物,必须重视股动脉的远端分支,因为骨内血供可向远端延伸至股骨髁上方约8厘米处。在所有这些手术中,必须考虑旋股深动脉干的变异和腘动脉的三叉分支情况。