摘要目的 总结股骨头内动脉走行研究方法的进展。方法 以“股骨颈骨折”“股骨头血供”“股骨头坏死”“支持带动脉定位”及“femoral neck fracture”“ blood supply of the femoral head ”“osteonecrosis of the femoral head ”“location of retinacular artery”等为中英文关键词在中国知网、万方数据、PubMed数据库检索2000年1月—2021年4月关于股骨头内动脉走行研究方法的文献,共检索到相关文献346篇,排除质量低、无法获取全文及内容不相符的文献,最终纳入文献38篇（中文文献15篇、英文文献23篇）,对其进行分析与总结。结果 目前用来研究股骨头内动脉走行的方法有灌注对比剂、增强MRI、超选择性数字减影血管造影（DSA）及显微灌注三维数字成像等,股骨头内血供主要来源于上、下、前3组支持带动脉,圆韧带动脉也参与股骨头血液的供应,3组支持带动脉在股骨头内彼此交通联结成血管网,分布于骺板上下方,但目前对股骨头内的血供及动脉走行特点仍未达成共识。结论 目前用于股骨头内动脉研究的方法及技术有了很大的进步,学者们对股骨头内的动脉解剖及血供模式有了一些认识,但为了满足临床的需要,尚需更进一步研究股骨头内的动脉解剖特点。
Abstract：Objective To summarize the research methods and research progress on the arterial passage of internal femoral head to provide theoretical reference for anatomical research and clinical application. Methods Using"股骨颈骨折""股骨头血供""股骨头坏死""支持带动脉定位"and"femoral neck fracture" "blood supply of the femoral head" "osteonecrosis of the femoral head" "location of retinacular artery" as keywords to identify relevant literatures on the progress of research methods on the arterial passage of the internal femoral head in CNKI Data, Wanfang Data and PubMed Data form January 2000 to April 2021. A total of 346 articles were retrieved, and 38 literatures were finally included and summarized after the literatures with low quality, unavailable full text, or irrelevant contents were excluded. Results The current methods used to study the femoral head arteries include perfusion contrast agent, enhanced magnetic resonance imaging, super-selective drving safety alerting, and microscopic perfusion 3D digital imaging. The blood supply of the femoral head comes from the superior, inferior, and anterior retinacular arteries. The ligamentum teres arteries also participate in the blood supply of the femoral head, and the three groups of retinacular arteries communicate with each other in the femoral head to form a vascular network, which is distributed above and below the epiphyseal plate. However, no consensus on the characteristics of blood supply and artery running in the femoral head has been established. Conclusion Although the methods and techniques used in the research of the femoral head artery have made great progress, and some understanding of the vascular anatomy and blood supply pattern in the femoral head has been obtained, further studies on the anatomical characteristics of the femoral head artery are still needed to meet clinical needs.
耿凯龙, 唐林峰, 巨积辉, 侯瑞兴. 股骨头内动脉走行研究方法的进展[J]. 中华解剖与临床杂志, 2022, 27(3): 208-212.
Geng Kailong, Tang Linfeng, Ju Jihui, Hou Ruixing. The progress of research methods on the arterial passage of the internal femoral head. Chinese Journal of Anatomy and Clinics, 2022, 27(3): 208-212.
Miyamoto RG, Kaplan KM, Levine BR, et al.Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures[J]. J Am Acad Orthop Surg,2008,16(10): 596-607. DOI:10.5435/00124635-200810000-00005.
[2]
Burge R, Dawson-Hughes B, Solomon DH, et al.Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025[J]. J Bone Miner Res, 2007,22(3):465-475. DOI: 10.1359/jbmr.061113.
[3]
张栋, 喻爱喜, 余国荣, 等. 中青年Garden Ⅲ和Ⅳ型股骨颈骨折两种手术方法的对比研究[J].中华显微外科杂志,2018,41(5):428-432. DOI: 10.3760/cma.j.issn.1001-2036.2018.05.004.Zhang D, Yu AX, Yu GR, et al.Comparative study of two different surgical methods for the treatment of Garden Ⅲ and Ⅳ femoral neck fractures in young adults[J]. Chin J Microsurg, 2018, 41(5):428-432. DOI: 10.3760/cma.j.issn.1001-2036.2018.05.004.
Ly TV, Swiontkowski MF.Treatment of femoral neck fractures in young adults[J]. J Bone Joint Surg Am,2008,90(10):2254-2266.
[6]
Davidovitch RI, Jordan CJ, Egol KA, et al.Challenges in the treatment of femoral neck fractures in the nonelderly adult[J]. J Trauma, 2010, 68(1):236-242. DOI: 10.1097/TA.0b013e3181c428ce.
[7]
Jack CR, Bennett DA, Blennow K, et al.NIA-AA research framework: toward a biological definition of Alzheimer's disease[J]. Alzheimers Dement, 2018, 14(4):535-562. DOI: 10.1016/j.jalz.2018.02.018.
[8]
吴涛华, 高连云, 林臻, 等. 直接前方入路空心螺钉固定治疗青壮年难复性股骨颈骨折[J].中华创伤骨科杂志,2020,22(9):765-770. DOI: 10.3760/cma.j.cn115530-20200601-00357.Wu TH, Gao LY, Lin Z, et al.Cannulated screw fixation directly via the anterior approach for femoral neck fractures difficultly reducible in young and middle-aged patients[J]. Chin J Orthop Trauma, 2020, 22(9):765-770. DOI: 10.3760/cma.j.cn115530-20200601-00357.
[9]
Slobogean GP, Sprague SA, Scott T, et al.Complications following young femoral neck fractures[J]. Injury, 2015,46(3):484-491. DOI: 10.1016/j.injury.2014.10.010.
刘学光, 孙振中, 宋升, 等. 经皮加压钢板结合旋股外侧动脉升支髂骨瓣移植治疗青壮年股骨颈骨折骨不连疗效观察[J].中国临床解剖学杂志, 2019, 37(5):559-562. DOI: 10.13418/j.issn.1001-165x.2019.05.015.Liu XG, Sun ZZ, Song S, et al.Effect of treatment of femoral neck fracture nonunion by percutaneous compression plate combined with ascending branch of lateral femoral circumflex artery iliac flap in young adults[J]. Chinese Journal of Clinical Anatomy, 2019, 37(5):559-562. DOI: 10.13418/j.issn.1001-165x.2019.05.015.
Zlotorowicz M, Szczodry M, Czubak J, et al.Anatomy of the medial femoral circumflex artery with respect to the vascularity of the femoral head[J]. J Bone Joint Surg Br, 2011, 93(11):1471-1474. DOI: 10.1302/0301-620X.93B11.26993.
[16]
Seeley MA, Georgiadis AG, Sankar WN.Hip vascularity: a review of the anatomy and clinical implications[J]. J Am Acad Orthop Surg, 2016,24(8):515-526. DOI: 10.5435/JAAOS-D-15-00237.
[17]
Zlotorowicz M, Czubak J, Caban A, et al. The blood supply to the femoral head after posterior fracture/dislocation of the hip, assessed by CT angiography[J]. Bone Joint J, 2013,95-B(11):1453-1457. DOI: 10.1302/0301-620X.95B11.32383.
[18]
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. DOI: 10.1302/0301-620x.82b5.10426.
[19]
Kalhor M, Horowitz K, Gharehdaghi J, et al.Anatomic variations in femoral head circulation[J]. Hip Int, 2012,22(3):307-312. DOI: 10.5301/HIP.2012.9242.
[20]
王华, 梅炯. 股骨头颈部血供的三维全景图制作及临床意义[J].同济大学学报(医学版), 2017, 38(6):46-51. DOI: 10.16118/j.1008-0392.2017.06.010.Wang H, Mei J.Developing three dimensional visualization of blood supply to the femoral head[J]. Journal of Tongji University(Medical Science), 2017, 38(6):46-51. DOI: 10.16118/j.1008-0392.2017.06.010.
[21]
Lavigne M, Kalhor M, Beck M, et al. Distribution of vascular foramina around the femoral head and neck junction: relevance for conservative intracapsular procedures of the hip[J]. Orthop Clin North Am, 2005,36(2):171-176, viii. DOI: 10.1016/j.ocl.2005.02.002.
[22]
王子华, 邱兴, 赵德伟. 基于三维重建的股骨头支持带血管的显微外科定位研究及临床意义[J].中国美容整形外科杂志, 2020, 31(3):171-174. DOI: 10.3969/j.issn.1673-7040.2020.03.014.Wang ZH, Qiu X, Zhao DW.Study on microsurgical vascular localization of femoral head retinacular vessels based on three-dimensional reconstruction and its clinical significance[J]. Chinese Journal of Aesthetic and Plastic Surgery, 2020, 31(3):171-174. DOI: 10.3969/j.issn.1673-7040.2020.03.014.
[23]
邱兴, 程亮亮, 王本杰, 等. 离体股骨头动脉显微灌注技术方法[J].中国临床解剖学杂志,2017,35(4):469-472. DOI: 10.13418/j.issn.1001-165x.2017.04.025.Qiu X, Cheng LL, Wang BJ, et al.Micro perfusion and quantitative analysis of the in vitro femoral head intraosseous artery[J]. Chinese Journal of Clinical Anatomy,2017, 35(4):469-472. DOI: 10.13418/j.issn.1001-165x.2017.04.025.
[24]
鲁亚杰, 李明辉, 龙作尧, 等. 基于血管灌注及硬组织切片技术的骨微血管研究方法[J].解剖学杂志,2019,42(1):85-87. DOI: 10.3969/j.issn.1001-1633.2019.01.023.Lu YJ, Li MH, Long ZY, et al.Method innovation of intraosseous microvessel study based on vascular perfusion and hard tissue slicing[J]. Chinese Journal of Anatomy, 2019,42(1):85-87. DOI: 10.3969/j.issn.1001-1633.2019.01.023.
[25]
黄连芳,朱觉新,梁洪英,等.通过亚纳米级硫酸钡进行骨内微血管显影及三维重建[J].广东医科大学学报, 2018, 36(1):49-52.DOI:10.3969/j.issn.1005-4057.2018.01.013.Huang LF, Zhu JX, Liang HY, et al.Intraosseous microangiography and 3D reconstruction using subnanometer barium sulfate[J]. Journal of Guangdong Medical College,2018,36(1):49-52. DOI: 10.3969/j.issn.1005-4057.2018.01.013.
[26]
张向南, 邓伟, 张松强, 等. 猪股骨头支持带动脉入头分支的解剖学研究[J].中国临床解剖学杂志,2021,39(2):130-133,139. DOI: 10.13418/j.issn.1001-165x.2021.02.003.Zhang XN, Deng W, Zhang SQ, et al.Anatomical study on the branch of pig femoral head retinacular artery[J]. Chinese Journal of Clinical Anatomy,2021,39(2):130-133,139. DOI: 10.13418/j.issn.1001-165x.2021.02.003.
[27]
Tucker FR.Arterial supply to the femoral head and its clinical importance[J]. J Bone Joint Surg Br, 1949,31B(1):82-93.
[28]
Trueta J. The normal vascular anatomy of the human femoral head during growth[J]. J Bone Joint Surg Br, 1957,39-B(2):358-394. DOI: 10.1302/0301-620X.39B2.358.
[29]
Sevitt S, Thompson RG.The distribution and anastomoses of arteries supplying the head and neck of the femur[J]. J Bone Joint Surg Br, 1965, 47:560-573.
[30]
Trueta J, Hassion MH. The normal vascular anatomy of the femoral head in adult man[J].J Bone Joint Surg Br,1953,35-B(3):442-461.DOI:10.1302/0301-620X.35B3.442.
[31]
Rego P, Mascarenhas V, Collado D, et al.Arterial topographic anatomy near the femoral head-neck perforation with surgical relevance[J]. J Bone Joint Surg Am, 2017, 99(14):1213-1221. DOI: 10.2106/JBJS.16.01386.
[32]
Boraiah S, Dyke JP, Hettrich C, et al.Assessment of vascularity of the femoral head using gadolinium (Gd-DTPA)-enhanced magnetic resonance imaging: a cadaver study[J]. J Bone Joint Surg Br, 2009, 91(1):131-137. DOI: 10.1302/0301-620X.91B1.21275.
[33]
Liu Y, Li M, Zhang M, et al.Femoral neck fractures: prognosis based on a new classification after superselective angiography[J]. J Orthop Sci, 2013, 18(3):443-450. DOI: 10.1007/s00776-013-0367-4.
[34]
Qiu X, Cheng LL, Wang BJ, et al.Micro perfusion and quantitative analysis of the femoral head intraosseous artery[J]. Orthop Surg, 2018, 10(1):69-74. DOI: 10.1111/os.12364.
[35]
赵斌, 范猛, 汪爱媛, 等. 骨内微血管和骨的同步三维显像及定量评价[J].中国矫形外科杂志, 2011, 19(24):2072-2076. DOI: 10.3977/j.issn.1005-8478.2011.24.14.Zhao B, Fan M, Wang AY, et al.Quantification and 3-D reconstruction of bone and intraosseous vessels[J]. Orthopedic Journal of China, 2011, 19(24):2072-2076. DOI: 10.3977/j.issn.1005-8478.2011.24.14.
[36]
Qiu X, Shi X, Ouyang J, et al.A method to quantify and visualize femoral head intraosseous arteries by micro-CT[J]. J Anat, 2016, 229(2):326-333. DOI: 10.1111/joa.12475.
[37]
Zhao D, Qiu X, Wang B, et al.Epiphyseal arterial network and inferior retinacular artery seem critical to femoral head perfusion in adults with femoral neck fractures[J]. Clin Orthop Relat Res, 2017, 475(8):2011-2023. DOI: 10.1007/s11999-017-5318-5.
[38]
Zhao D, Wang Z, Wang B, et al.Revascularization of the femoral head by anastomosis of superior retinacular vessels for the treatment of femoral neck fracture: a case report[J]. Microsurgery, 2016, 36(5):426-429. DOI: 10.1002/micr.30029.
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