Anatomic characteristics and clinical significance of porcine femoral-head retinacular veins
Geng Kailong1,2, Tang Linfeng1, Zhang Xiangnan1, Wang Hongyu1,2, Liu Hongdong1,2, Deng Wei1,2, Wang Dingsong1,2, Hou Ruixing1,3
1Department of Orthopedics,Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China; 2Clinical College of Suzhou Medical College of Soochow University, Suzhou 215123, China; 3 Clinical College of Yangzhou University Medical College, Suzhou 225009, China
Abstract：Objective To explore the anatomic characteristics of the number, distribution, and diameter of retinacular veins of the femoral head in pigs and the feasibility of anastomosing fractured retinacular veins to reconstruct femoral head venous return. Methods A total of 35 fresh pig femoral head specimens were collected, and the perihip vessels were not injured. (1) The medial and lateral femoral circumflex veins and main branches of the femoral head were found under the microscope in 25 cases. After gelatin-barium sulfate solution was injected, the perivascular soft tissues were removed to complete the preparation of retinacular vein perfusion specimens of the femoral head. The traveling mode, distribution, and number of retinacular veins in each group of femoral head were observed by naked eye and microscopy, and the external diameter of retinacular veins in each group was measured by a microscale. A clockwork dial (clock dial) was used to locate the retinacular veins of each group. (2) Another 10 specimens were transected in the middle part of the femoral neck to prepare the femoral neck fracture model. Anatomical reduction and internal fixation of the fracture model were completed with a Kirschner wire. According to the observation results of femoral head retinacular vein perfusion, the proximal and distal ends with the widest external diameter were selected for end-to-end anastomosis. After anastomosis, gelatin-barium sulfate solution was perfused to observe the patency of anastomosis and the filling of retinacular veins in other parts of the femoral head. Results (1) The 25 cases of pig femoral head retinacular vein perfusion showed that the femoral head retinacular veins ran below the femoral neck retinacular after perforating through the nourishing foramen. The number of retinacular veins was 1-7 (14.2±2.6). Based on the distribution position of retinacular veins in the femoral neck, the femoral head retinacular veins of the pig was divided into four groups: anterior, posterosuperior, posterior, and posteroinferior. The number of veins in the anterior, posterosuperior, posterior, and posteroinferior groups were 2-6 (3.4±0.9), 1-6 (4.0±1.1), 1-3 (1.7±0.6), and 2-7 (5.0±1.5), respectively, and the positions on the dial were 2:20-4:30, 11:10-1:40, 8:50-11:00, and 6:30-8:20. The external diameters of retinacular veins were 0.25-1.40 (0.69±0.18), 0.30-1.50 (0.71±0.20), 0.20-1.10 (0.60±0.15), and 0.30-1.50 (0.75±0.19) mm in the anterior, posterosuperior, posterior, and posteroinferior groups, respectively. (2) End-to-end anastomosis of fractured retinacular veins was successfully completed in all 10 models of femoral neck fracture. After anastomosis, gelatin-barium sulfate solution can pass the anastomotic stoma smoothly, and barium sulfate solution filled the other retinacular veins of the femoral head after continuous perfusion. Conclusion The number and location of retinacular veins in femoral head are relatively constant, and their external diameter in the posteroinferior group is the widest. The fractured retinacular veins in the posteroinferior group can be selected and anastomosed for femoral neck fracture, which can restore the venous return of the femoral head.
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2023, Vol. 28 
