股骨髓内钉进针点对股骨近端血供影响的解剖学研究
The effects of entry points of femoral intramedullary nail on the blood supply of proximal femur: anatomic study
目的 推导股骨髓内钉进针点对股骨近端血供的影响。 方法 正常成人防腐髋关节标本68侧，观测旋骨外侧动脉、旋骨内侧动脉、臀上动脉和臀上动脉在股骨近端的分布、位置及与肌肉的关系，以及在股骨近端的血管吻合情况。 结果 10.3%（7侧）在臀小肌附着处旋股外侧动脉升支与旋股内侧动脉深支吻合， 89.7%（61侧）旋股内侧动脉深支与臀下动脉相吻合，70.6%（48侧）旋股内侧动脉深支与臀上动脉相吻合。 结论 当旋股内侧动脉损伤时其血供可由臀上、臀下动脉吻合补偿，而并非为旋股外侧动脉代偿。
Objective To explore the blood supply damage around the proximal femur during the process of femoral intramedullary nailing. Methods The study was performed on 68 adult antiseptic hip joint specimens. The distribution and location of medial femoral circumflex artery (MFCA), lateral femoral circumflex artery (LFCA), superior gluteal artery(SGA), inferior gluteal artery(IGA), and their relationship with adjacent muscles were exposed, as well, their anastomosis around proximal femur were measured. Results Anastomosis between LFCA's descending branch and MFCA's deep branch appeared in 7 cases (10.3%), and anastomosis between MFCA's deep branch and IGA in 61 cases (89.7%), anastomosis between MFCA's deep branch and SGA in 48 cases (70.6%). Conclusions Instead of LFCA, the deep branch of MFCA may be capable of being compensated by IGA and SGA together.
Proximal femur / Medial femoral circumflex artery / Yascular anastomosis / Anatomy
[1] Helmy N, Jando VT, Lu T, et al. Muscle function and functional outcome following standard antegrade reamed intramedullary nailing of isolated femoral shaft fractures
[J]. J Orthop trauma, 2008, 22（1）: 10-15.
[2] Miller SD, Burkart B, Damson E, et al. The effect of the entry hole for an intramedullary nail on the strength of the proximal femur
[J]．J Bone Joint Surg Br, 1993, 75（2）:202-206.
[3] Dodenhoff RM, Dainton JN, Hutchins PM. Proximal thigh pain after femoral nailing. Causes and treatment
[J]． J Bone Joint Surg Br, 1997, 79(5): 738-741.
[4] Ansari Moein CM, Verhofstad MH, Bleys RL,et al. Soft tissue anatomy around the hip and its implications for choice of entry point in antegrade femoral nailing
[J]． Clin Anat, 2008,21(6): 568-574.
[5] Streubel PN, Wong AH, Ricci WM, et al. Is there a standard trochanteric entry site for nailing of subtrochanteric femur fractures
[J]. J Orthop Trauma, 2011,25(4): 202-207.
[6] Dora C, Leunig M, Beck M, et al. Entry point soft tissue damage in antegrade femoral nailing: a cadaver study
[J]. J Orthop Trauma, 2001,15(7): 488-493.
[7] Gautier E, Ganz K, Krügel N, et al. Anatomy of the medial femoral circumflex artery and its surgical implications
[J]．J Bone Joint Surg Br, 2000, 82(5): 679-683.
[9] Orler R, Hersche O, Helfet DL, et al. Die avaskul?re Hüftkopfnek-rose als schwerwiegende Komplikation nach Marknagelung beiKindern und Jungendlichen
[J]． Unfallchirurgie, 1998, 101(6): 495-499.
[10] 阮默，徐达传，汪新民，等.闭孔动脉吻合支的解剖学研究及其临床意义
[J]．中国临床解剖学杂志，2003，21(3)：215-219．
[11] Gardner MJ, Robertson WJ, Boraiah S, et al. Anatomy of the greater trochanteric 'bald spot': a potential portal for abductor sparing femoral nailing
[J]? Clin Orthop Relat Res, 2008, 466(9): 2196-2200.
[12] Kale SP, Patil N, Pilankar S, et al. Correct anatomical location of entry point for antegrade femoral nailing
[J]．Injury, 2006,37(10): 990-993.
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