Anatomia vascolare
Tóm tắt
Vascular contribution to the femoral head is basically due to the arteria circumflexa femoris medialis (MFCA) [1–19], coming from the ramus profundus: the postero-superior and postero-inferior retinacular vessels run along the intertrochanteric ridge, penetrating the capsule and continuing under the synovia to the bone-cartilage junction. The rounded ligament arteria and the circumflexa lateralis also contribute to the vascularization of the proximal femural epiphysis but their contribution is much lesser [1, 2, 4, 12]. Every surgical intervention that includes dislocation manoeuvers and/or circumferential capsulotomy and is meant to preserve proximal epiphysis bone must ensure preservation of the vascular axis [1–3, 21]. This can be obtained by saving and conserving the insertion of the external obturator that protects the deep branch of MCFA from excessive strain [1, 21].
Tài liệu tham khảo
Gautier E, Ganz K, Krügel N et al (2000) Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 82:679–683
Grose AW, Gardner MJ, Sussmann PS et al (2008) The surgical anatomy of the blood supply to the femoral head: description of the anastomosis between the medial femoral circumflex and inferior gluteal arteries at the hip. J Bone Joint Surg Br 90:1298–1303
Ganz R, Gill TJ, Gautier E et al (2001) Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 83:1119–1124
Trueta J, Harrison MH (1953) The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg Br 35:442–461
Dora C, Leunig L, Beck M et al (2001) Entry point soft tissue damage in antegrade femoral nailing: a cadaver study. J Orthop Trauma 15:488–493
Gray H (1918) Anatomy of the human body, 20th edn. Lea and Febiger, Philadelphia
Hollinshead WH (1985) Textbook of anatomy, 4th edn. Harper and Row, Philadelphia
Chung SM (1976) The arterial supply of the developing proximal end of the human femur. J Bone Joint Surg Am 58:961–970
Judet J, Judet R, LaGrange J, Dunoyer J (1955) A study of the arterial vascularization of the femoral neck in the adult. J Bone Joint Surg Am 37:663–680
Harty M (1966) Some aspects of the surgical anatomy of the hip joint. J Bone Joint Surg Am 48:197–202
Sevitt S, Thompson RG (1965) The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg Br 47:560–573
Williams PL, Bannister R (1995) Gray’s anatomy. 38th edn. Churchill Livingstone, London
Howe WW Jr, Lacey T, Schwartz RP (1950) A study of the gross anatomy of the arteries supplying the proximal portion of the femur and the acetabulum. J Bone Joint Surg Am 32:856–866
Crock HV (1980) An atlas of the arterial supply of the head and neck of the femur in man. Clin Orthop 152:17–27
Jedral T, Anyzewski P, Ciszek B, Benke G (1996) Vascularization of the hip joint in the human fetuses. Folia Morphol (Warsz) 55:293–294
McMahon SJ, Young D, Ballok Z et al (2006) Vascularity of the femoral head after Birmingham hip resurfacing. A technetium Tc 99m bone scan/single photon emission computed tomography study. J Arthroplasty 21:514–521
Nork SE, Schär M, Pfander G et al (2005) Anatomic considerations for the choice of surgical approach for hip resurfacing arthroplasty. Orthop Clin North Am 36:163–170
Schoeniger R, Espinosa N, Sierra RJ et al (2009) Role of the extraosseous blood supply in osteoarthritic femoral heads? Clin Orthop 467:2235–2240
Webber MM, Bennett LR, Wagner J, Patton DL (1967) Demonstration of the vascularity of the femoral head. J Nucl Med 8:403–404
Hulth A (1956) Intra-osseous venographies of medial fractures of the femoral neck; the residual vascularity of the head fragment in different types of fractures and its relation to the prognosis. Acta Chir Scand Suppl 214:1–112
Nötzli HP, Siebenrock KA, Hempfing A et al (2002) Perfusion of the femoral head during surgical dislocation of the hip. Monitoring by laser Doppler flowmetry. J Bone Joint Surg Br 84:300–304
