股骨头圆韧带动脉血供的相关研究
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摘要
目的评测股骨颈骨折后股骨头圆韧带动脉血供情况,探讨其临床治疗方法,为可以采用闭合复位内固定保留股骨头治疗股骨颈骨折取得理论依据。
方法在70例行人工髋关节置换术中,断头取出后,肉眼直视下观察干净纱布擦拭前后髋臼窝圆韧带动脉的出血情况。术后把切除的圆韧带送检病理,横断圆韧带制作病理切片观察圆韧带动脉通畅情况。
结果70例观察对象,干净纱布擦拭前可见圆韧带动脉出血而擦拭后仍有出血共有44例;擦拭前可见圆韧带动脉出血而擦拭后未见出血共有13例;擦拭前后均未见出血13例。术后送检圆韧带行病理切片提示圆韧带动脉通畅38例,不通畅者32例。运用SPASS 18.0软件统计分析,P<0.0167,60岁以下年龄组与另外两组圆韧带动脉通畅情况有差别,有统计学意义。
结论综合评估股骨颈骨折后股骨头圆韧带动脉血供情况,60岁以下年龄组股骨颈骨折后患者股骨头圆韧带动脉总体通畅情况良好,Garden III型及以下股骨颈骨折可以行保留股骨头治疗;Garden IV型及60岁以上股骨颈骨折患者建议一期行人工假体置换术。
Objective To evaluate the round ligament artery of the femoral head after femoral neck fracture and to discuss the therapy in clinics, and get the theoretical basis for the closed reduction and internal fixation.
Methods We observed the round ligament artery bleeding by eye before and after swabbing in 70 cases in the THA. And made the pathological inspection of the round ligament to make the transection of the round ligament and make sure whether the round ligament artery is smooth or not.
Results We observed the round ligament artery bleeding by eye in 70 cases in the THA. 44cases of round ligament artery were observed bleeding before and after swabbing.13cases of round ligament artery were observed bleeding before after swabbing. while 13 cases not bleeding after swabbing. 13cases of round ligament artery were not observed bleeding before and after swabbing.38 cases of round ligament artery were smooth while 32 cases of vascular narrow or unseen. Group under 60 years was statistically significant compared with the other two groups, according to the SPSS 18.0 Software (P <0.0167).
Conclusion The blood supply of femoral head after femoral neck fracture in the group under the age of 60 is in good condition. We could retain the femoral head of femoral neck fracture in the treating of the Garden I, II, III. Garden IV-type and people above 60 with femoral neck fracture are recommended to take the THA.
方法在70例行人工髋关节置换术中,断头取出后,肉眼直视下观察干净纱布擦拭前后髋臼窝圆韧带动脉的出血情况。术后把切除的圆韧带送检病理,横断圆韧带制作病理切片观察圆韧带动脉通畅情况。
结果70例观察对象,干净纱布擦拭前可见圆韧带动脉出血而擦拭后仍有出血共有44例;擦拭前可见圆韧带动脉出血而擦拭后未见出血共有13例;擦拭前后均未见出血13例。术后送检圆韧带行病理切片提示圆韧带动脉通畅38例,不通畅者32例。运用SPASS 18.0软件统计分析,P<0.0167,60岁以下年龄组与另外两组圆韧带动脉通畅情况有差别,有统计学意义。
结论综合评估股骨颈骨折后股骨头圆韧带动脉血供情况,60岁以下年龄组股骨颈骨折后患者股骨头圆韧带动脉总体通畅情况良好,Garden III型及以下股骨颈骨折可以行保留股骨头治疗;Garden IV型及60岁以上股骨颈骨折患者建议一期行人工假体置换术。
Objective To evaluate the round ligament artery of the femoral head after femoral neck fracture and to discuss the therapy in clinics, and get the theoretical basis for the closed reduction and internal fixation.
Methods We observed the round ligament artery bleeding by eye before and after swabbing in 70 cases in the THA. And made the pathological inspection of the round ligament to make the transection of the round ligament and make sure whether the round ligament artery is smooth or not.
Results We observed the round ligament artery bleeding by eye in 70 cases in the THA. 44cases of round ligament artery were observed bleeding before and after swabbing.13cases of round ligament artery were observed bleeding before after swabbing. while 13 cases not bleeding after swabbing. 13cases of round ligament artery were not observed bleeding before and after swabbing.38 cases of round ligament artery were smooth while 32 cases of vascular narrow or unseen. Group under 60 years was statistically significant compared with the other two groups, according to the SPSS 18.0 Software (P <0.0167).
Conclusion The blood supply of femoral head after femoral neck fracture in the group under the age of 60 is in good condition. We could retain the femoral head of femoral neck fracture in the treating of the Garden I, II, III. Garden IV-type and people above 60 with femoral neck fracture are recommended to take the THA.
引文
[1] THORN GREN KG, HOMMELA ,NOMMN PO,et al.Epidemiology of femoral neck fracture[J].lnjury,2002(Suppl3):33.
[2]余昱,董福慧.股骨颈骨折三种内固定构型的稳定性比较研究[J].中国骨伤,2003,13(6):331-333 .
[3] Taylor CL,et al.Superiority of the deep coir-cumflex iliac vessels as the supply for freegroin flaps .Plast Reconstr Surg,1979,65:595.
[4]刘全祥,刘雪龙,常俊齐,等.带血管蒂组织瓣治疗青壮年高位股骨颈骨折18例分析[J].中国误诊学杂志,2007,7(19):4656-4657.
[5]王明森,庄义洲,黄伟斌.缝匠肌带骨瓣移植三梭内固定器固定治疗中育年股骨颈骨折临床观察[J].中医正骨,2007,19(2):47-49.
[6]林月秋,徐永清,柏利,等.无柄人工髋关节置换术的初步临床应用.中华骨科杂志,2010,30(6):554-557.
[7]童培建,金红婷,何帮剑,等.干细胞介入治疗股骨头缺血性坏死的实验研究.中华骨科杂志,2010,30(6):600-606.
[8] Bhandari M,Devereaux PJ,Tornetta P 3rd ,et al.Operative management of displaced femoral neck fractures in elderly patients.An international survey. J Bone Joint Surg [Am],2005,87(9):2122-2130.
[9]胥少汀,葛宝丰,徐印坎.实用骨科学[M].北京:人民军医出版社,2008:687-697.
[10]Sugamoto K,et al. Clin Orthop 1998,353:138-147.
[11]许本柯,徐达传,王兵等.股骨头血供特点及临床意义.解剖学杂志.2007,30(3):371-373.
[12]袁海胜.闭合复位微创内固定治疗青壮年股骨颈骨折35例分析.中国误诊学杂志.2009,7(9):1682-1683.
[13]王亮,朱冬承,戈兵等.早期双侧小切口复位固定治疗青壮年股骨颈骨折.Journal of Minimally Invasive Medicine,2010, 2(5):108-110.
[14]邱贵兴,戴剋戎.骨科手术学[M].人民卫生出版社,2010:305-312.
[15]Canale ST. Campbell's operative orthopaedica[M],9th,ehs Missonuri:Mo-sby.1998:2146.
[16]Ruedi.T.P,Buckley.R.E,Moran.C.G.AO Principles of Fracture Management[M].上海科学技术出版社,2010:7.
[17]陈先军,庞清江.数字减影造影观察股骨颈骨折对股骨头血供变化的影响.现代实用医学,2009,3(21):201-204.
[1]孙建,庞清江.股骨头血供及股骨颈骨折血管破坏研究进展.现代实用医学,2006,18(3):203-209.
[2]胥少汀,葛宝丰,徐印坎.实用骨科学[M].北京:人民军医出版社,2008:687-697.
[3]Weathersby HT.The origin of the artery of the ligamentum teres femoris.J Bone Joint Surg[Am],1959,41-A,Issue 2:261-263.
[4]阮默,徐达传.CHINESE JOURNAL OF CLINICAL ANATOMY 2003,1(21):92-93
[5]吉士俊,刘卫东,马瑞雪,等.胎儿髋关节形态发育变化的观察[J] .中华骨科杂志, 1988, 8(5): 264-266.
[6] Kam egaya M, Morya H, Tsuchiya K, et al. Arthrography of early Perthes, disease of the ligam entum teres as a cause of subluxation[J] . Br J Bone Joint Surg, 1989, 71(3) : 413-417.
[7]Chen HH, Li AFY, Li KC,et al.Adapt at ions of ligamentum teres in is chemic necrosis of human f emoral head[J].Clin Orthop,1996,328: 268-275.
[8]JacquesT.Super selective Angiography of the Hip.Radiology,1977,124:648-650.
[9]Gautier E,Ganz K,Krugel N,et a1.Anatomy of the medial femoral circu-m flex artery and its surgical implications.J Bone Joint Surg,2001,82(7):679-683.
[10] Fritsch H, Hegemann L. Devel opment of the ligamentum capit is f emoris and the artery with the same name[ J] . Z Orthop Ihre Grenzgeb, 1991,129( 5) : 447-452.
[11]吉士俊,马瑞雪,周永德.小儿髋关节外科,第一版.北京:人民卫生出版社,2005,1(1):23-24,48-57.
[12]苗登顺,吴永沐.胎儿和婴儿股骨近端的血供及其临床意义[J] .中国临床解剖学杂志,1988,6(2):68-71.
[13]Lee MC,Eberson CP.Growth and Development of the Child's Hip.Orthop Clin Nort Am,2006,37(2):119-132.
[14]Merkle U.On aging changes on the arteries of the ligamentum capitis femoris.Zeitschrift Fur Alternsforschung,1965,18(1):10-12.
[15]祁建,李乐华,高远孚,等.股骨头血供来源的应用解剖学研究[J].中华骨科杂志,1987,7(3):220-224.
[16]朱丹杰,齐新生.股骨头血液供应与股骨头缺血性坏死研究进展.国外医学外科学分册,2002,29(1):40-42.
[17]Sugamoto K,et al. Clin Orthop 1998,353:138-147.
[18]许本柯,徐达传,王兵等.股骨头血供特点及临床意义.解剖学杂志.2007,30(3):371-373.
[19]Fuss FK,Bacher A.New aspects of the morphology and function of the human hip joint ligaments.Am J Anatomy,1991,192(1):1-13.
[20]Staheli LT,Dion M,Tuell JI.The effect of the inverted limbus onclosed management of congenital hip dislocation.Clin Orthop,1978,137:163-166.
[21]Gage JR,Winter RB.Avascular Necrosis of the Capital Femoral Epiphysisas a Complication of Closed Reduction of Congenital Dislocation of the Hip.A Critical Review of Twenty Years’Experience at Gillette Children’s Hospital.J Bone and Joint Surg,1972,54-A:373-388.
[22]Li AF,Li KC,Chen HH,et al.Biomechanical functions of ligatumentum teres.Proceedings 1993 International Society of Biomechanics 14th Congress.Paris,1993:794-795.
[23]Walker JM.Growth characteristics of the fetal ligament of the headof femur:significance in congenital hip disease.Yale J Biol Med,1980,53(4):307-316.
[24]Lang A,Balint J.Anatomy of ligamentum teres femoris.Acta Morphologica Academiae Scientiarum Hungaricae,1953,3(3):275-285.
[25]Tan CK, Wong WC. Absence of the ligament of head of femur in the hu man hip joint[J].Singapore Med J,1990,31(4):360-363.
[26] Shat sillo OI, Ariel BM. The anatomicofunctional characteristics of the hipjoint[J].Morf ologiia,1996,110(6):112-115.
[27] Fuss FK, Bacher A. New aspects of the morphology and function of thehuman hip joint ligaments[J].Am J Anatomy,1991,192(1):1-13.
[28] Neverrov VA, Shilnikov VA. Amethod for forming an artificialligament for the femur head in endoprosthesis [J] . Vestn Khir Im I I Grek ,1993, 151(7- 12):81-83.
[29] Aithal VK, Jenkins DH. Stabili zation of a dislocating spastic hip with a carbon fiber ligament[J].Act a Orthop Scand,1992,63(6):679.
[30]Bassett GS,et a1.Clin Orthop 1997,340:158—164.
[31]Drescher W,et a1.Acta Orthop Scand 1999,70(5):439—445.
[32]Konishiike T,et a1.J Bone Joint Surg Br 1999,81(4):596—599
[33]Robben SG,et a1.AJR 2000;174(6):1629—1634.
[34] Villar RN. Hip Arth roscopy[M] .Oxford, England: Butterworth Heine mann,1992.446-485.
[35] Gray AJ, Vi llar RN. The ligamentum teres of the hip: An arthroscopic classif ication of its pathology[J].Arthroscopy,1997,13(5):575-578.
[36] Duff SR. Hip inst ability in young adult ,broiler fowls[J] .J Comp Pathol,1985,95(3):373-382.
[37]Lee GR.Disorders of the hip.2nd ed.New York:Linppincott,1983.36-42.
[2]余昱,董福慧.股骨颈骨折三种内固定构型的稳定性比较研究[J].中国骨伤,2003,13(6):331-333 .
[3] Taylor CL,et al.Superiority of the deep coir-cumflex iliac vessels as the supply for freegroin flaps .Plast Reconstr Surg,1979,65:595.
[4]刘全祥,刘雪龙,常俊齐,等.带血管蒂组织瓣治疗青壮年高位股骨颈骨折18例分析[J].中国误诊学杂志,2007,7(19):4656-4657.
[5]王明森,庄义洲,黄伟斌.缝匠肌带骨瓣移植三梭内固定器固定治疗中育年股骨颈骨折临床观察[J].中医正骨,2007,19(2):47-49.
[6]林月秋,徐永清,柏利,等.无柄人工髋关节置换术的初步临床应用.中华骨科杂志,2010,30(6):554-557.
[7]童培建,金红婷,何帮剑,等.干细胞介入治疗股骨头缺血性坏死的实验研究.中华骨科杂志,2010,30(6):600-606.
[8] Bhandari M,Devereaux PJ,Tornetta P 3rd ,et al.Operative management of displaced femoral neck fractures in elderly patients.An international survey. J Bone Joint Surg [Am],2005,87(9):2122-2130.
[9]胥少汀,葛宝丰,徐印坎.实用骨科学[M].北京:人民军医出版社,2008:687-697.
[10]Sugamoto K,et al. Clin Orthop 1998,353:138-147.
[11]许本柯,徐达传,王兵等.股骨头血供特点及临床意义.解剖学杂志.2007,30(3):371-373.
[12]袁海胜.闭合复位微创内固定治疗青壮年股骨颈骨折35例分析.中国误诊学杂志.2009,7(9):1682-1683.
[13]王亮,朱冬承,戈兵等.早期双侧小切口复位固定治疗青壮年股骨颈骨折.Journal of Minimally Invasive Medicine,2010, 2(5):108-110.
[14]邱贵兴,戴剋戎.骨科手术学[M].人民卫生出版社,2010:305-312.
[15]Canale ST. Campbell's operative orthopaedica[M],9th,ehs Missonuri:Mo-sby.1998:2146.
[16]Ruedi.T.P,Buckley.R.E,Moran.C.G.AO Principles of Fracture Management[M].上海科学技术出版社,2010:7.
[17]陈先军,庞清江.数字减影造影观察股骨颈骨折对股骨头血供变化的影响.现代实用医学,2009,3(21):201-204.
[1]孙建,庞清江.股骨头血供及股骨颈骨折血管破坏研究进展.现代实用医学,2006,18(3):203-209.
[2]胥少汀,葛宝丰,徐印坎.实用骨科学[M].北京:人民军医出版社,2008:687-697.
[3]Weathersby HT.The origin of the artery of the ligamentum teres femoris.J Bone Joint Surg[Am],1959,41-A,Issue 2:261-263.
[4]阮默,徐达传.CHINESE JOURNAL OF CLINICAL ANATOMY 2003,1(21):92-93
[5]吉士俊,刘卫东,马瑞雪,等.胎儿髋关节形态发育变化的观察[J] .中华骨科杂志, 1988, 8(5): 264-266.
[6] Kam egaya M, Morya H, Tsuchiya K, et al. Arthrography of early Perthes, disease of the ligam entum teres as a cause of subluxation[J] . Br J Bone Joint Surg, 1989, 71(3) : 413-417.
[7]Chen HH, Li AFY, Li KC,et al.Adapt at ions of ligamentum teres in is chemic necrosis of human f emoral head[J].Clin Orthop,1996,328: 268-275.
[8]JacquesT.Super selective Angiography of the Hip.Radiology,1977,124:648-650.
[9]Gautier E,Ganz K,Krugel N,et a1.Anatomy of the medial femoral circu-m flex artery and its surgical implications.J Bone Joint Surg,2001,82(7):679-683.
[10] Fritsch H, Hegemann L. Devel opment of the ligamentum capit is f emoris and the artery with the same name[ J] . Z Orthop Ihre Grenzgeb, 1991,129( 5) : 447-452.
[11]吉士俊,马瑞雪,周永德.小儿髋关节外科,第一版.北京:人民卫生出版社,2005,1(1):23-24,48-57.
[12]苗登顺,吴永沐.胎儿和婴儿股骨近端的血供及其临床意义[J] .中国临床解剖学杂志,1988,6(2):68-71.
[13]Lee MC,Eberson CP.Growth and Development of the Child's Hip.Orthop Clin Nort Am,2006,37(2):119-132.
[14]Merkle U.On aging changes on the arteries of the ligamentum capitis femoris.Zeitschrift Fur Alternsforschung,1965,18(1):10-12.
[15]祁建,李乐华,高远孚,等.股骨头血供来源的应用解剖学研究[J].中华骨科杂志,1987,7(3):220-224.
[16]朱丹杰,齐新生.股骨头血液供应与股骨头缺血性坏死研究进展.国外医学外科学分册,2002,29(1):40-42.
[17]Sugamoto K,et al. Clin Orthop 1998,353:138-147.
[18]许本柯,徐达传,王兵等.股骨头血供特点及临床意义.解剖学杂志.2007,30(3):371-373.
[19]Fuss FK,Bacher A.New aspects of the morphology and function of the human hip joint ligaments.Am J Anatomy,1991,192(1):1-13.
[20]Staheli LT,Dion M,Tuell JI.The effect of the inverted limbus onclosed management of congenital hip dislocation.Clin Orthop,1978,137:163-166.
[21]Gage JR,Winter RB.Avascular Necrosis of the Capital Femoral Epiphysisas a Complication of Closed Reduction of Congenital Dislocation of the Hip.A Critical Review of Twenty Years’Experience at Gillette Children’s Hospital.J Bone and Joint Surg,1972,54-A:373-388.
[22]Li AF,Li KC,Chen HH,et al.Biomechanical functions of ligatumentum teres.Proceedings 1993 International Society of Biomechanics 14th Congress.Paris,1993:794-795.
[23]Walker JM.Growth characteristics of the fetal ligament of the headof femur:significance in congenital hip disease.Yale J Biol Med,1980,53(4):307-316.
[24]Lang A,Balint J.Anatomy of ligamentum teres femoris.Acta Morphologica Academiae Scientiarum Hungaricae,1953,3(3):275-285.
[25]Tan CK, Wong WC. Absence of the ligament of head of femur in the hu man hip joint[J].Singapore Med J,1990,31(4):360-363.
[26] Shat sillo OI, Ariel BM. The anatomicofunctional characteristics of the hipjoint[J].Morf ologiia,1996,110(6):112-115.
[27] Fuss FK, Bacher A. New aspects of the morphology and function of thehuman hip joint ligaments[J].Am J Anatomy,1991,192(1):1-13.
[28] Neverrov VA, Shilnikov VA. Amethod for forming an artificialligament for the femur head in endoprosthesis [J] . Vestn Khir Im I I Grek ,1993, 151(7- 12):81-83.
[29] Aithal VK, Jenkins DH. Stabili zation of a dislocating spastic hip with a carbon fiber ligament[J].Act a Orthop Scand,1992,63(6):679.
[30]Bassett GS,et a1.Clin Orthop 1997,340:158—164.
[31]Drescher W,et a1.Acta Orthop Scand 1999,70(5):439—445.
[32]Konishiike T,et a1.J Bone Joint Surg Br 1999,81(4):596—599
[33]Robben SG,et a1.AJR 2000;174(6):1629—1634.
[34] Villar RN. Hip Arth roscopy[M] .Oxford, England: Butterworth Heine mann,1992.446-485.
[35] Gray AJ, Vi llar RN. The ligamentum teres of the hip: An arthroscopic classif ication of its pathology[J].Arthroscopy,1997,13(5):575-578.
[36] Duff SR. Hip inst ability in young adult ,broiler fowls[J] .J Comp Pathol,1985,95(3):373-382.
[37]Lee GR.Disorders of the hip.2nd ed.New York:Linppincott,1983.36-42.