股骨头、颈骨内静脉构筑特点及意义

Characters of intra-osteal venous angioarchitecture of femoral head and cervix and its potential significance

目的:为Legg-Perthes病的发病机理及临床诊治提供可靠的形态学资料。方法:采用血管透明法、组织切片微血管定量法和扫描电镜法对25例胎儿、新生儿的股骨头、颈骨内静脉、微血管构筑特点进行观察及定量分析。结果:骨内静脉包括:前、后、上、下骺静脉,内骺静脉,前、后、上、下干骺静脉。一条微动脉一般有两条微静脉伴行,微静脉间有丰富的横行吻合支。在微动脉移行为毛细血管的部位,常可见到环形缩窄。毛细血管相互连结成网,罩套在微动脉外周。其多以锐角的方式注入微静脉干,最后汇人骺静脉。股骨颈内微血管的构筑方式基本同股骨头,但较股骨头内为少。胎儿及新生儿股骨头内微血管、毛细血管数量较股骨颈内丰富,新生儿股骨头、颈内毛细血管数量较胎儿为少。结论:股骨头、颈骨内骺静脉的排布方式、微血管构筑特点为进一步解释Legg-Perthes病的发病机理提供了形态学依据,同时为临床设计Legg-Perthes病早期骨内、外双重介入治疗方案提供了可能。

Objective：To provide reliable and direct morphological data for the etiopathogenesis of Legg -Perthes disease and its clinical treatment. Methods： Blood vessel transillumination, histotomy by microangium quantitation and scanning electron microscope were applied to observe the characters of intra -osteal venous angioarchitecture of the femoral head and cervix of 25 fetuses, neonates and children,and after that quantitive analysis was used. Resul,ts：The intra-osteal veins of the hip joints included ：anterior, posterior,superior and inferior medial epiphysis venae and anterior,posterior,superior,interior metaphysis venae. An arteriole was accompanied by two veinules with plenty of laterigrade ramus anastomoticus. Ring -shaped coarctation was frequently observed at the site of transmigration from arterioles to capillaries that formed web covering arterioles and joined the veinule stem in acute angle, which flowed into metaphysis venae at last. The angioarchitecture of the femoral head and cervix was similar to that of the femoral head,with .less vessles in the former. More microangium and capillaries were found in the femoral head of fetus or neonate compared to their femoral cervix,and the number of capillaries in femoral head and cervix of neonate was less than that of fetus. Conclusion： The assignment of metaphysis venae and the characters of angioarchitecture in the femoral head and cervix provide the morphological basis for interpreting the e tiopathogenesis of Legg-Perthes disease,and moreover,the clinical strategies of treating Legg-Perthes disease in the early stage could be designed as extra-and intra-osteal double intervention.