股骨滋养动脉髓内行径与髓内针固定的关系

Relationship between tract of nutrient artery in medullary cavity and fixation of intramedullary nailing in the femur

目的 :为了减少应用髓内针对股骨髓内血供造成的损伤。方法 :观察了 2 0根尸体股骨的髓内血管行径 ,另各用 2根股骨进行扩髓与不扩髓髓内针固定 ,比较其对髓内血管的损伤程度。结果 :①60 %股骨有上、下 2条滋养动脉 ,40 %仅有 1条上滋养动脉 ,其中上滋养动脉为主要动脉。上、下滋养动脉的髓腔进入点 ,分别位于股骨中、上 1/3交界处及中点附近。②滋养动脉进入骨髓腔分成升、降两支髓内动脉 ,其主干均位于髓腔后方并紧贴髓腔壁行走 (仅上滋养动脉的部分远侧分支位于侧壁及前壁 )。③扩大髓腔后 ,髓内血管均被破坏 ,不扩髓腔可保存髓内血管主干。结论 :①应用髓内针时 ,只要能获得可靠的固定 ,不扩大髓腔可以避免损伤髓内血管主干 ;②股骨髓内针开口应指向后侧 ( 175°～ 182°) ;③股骨中、上段骨折手术时 ,应避免剥离近粗线的骨膜 ,以免损伤上滋养动脉。

Objective: To decrease the injury of medullary vessels by using intramedullary (IM) nailing in the femur. Methods: The tracks of medullary vessels were observed on 20 cadaveric femurs. The injury degree of medullary vessels by IM nailing fixation with IM reaming was compared with that without IM reaming on 2 femurs.Results: Sixty percent of the femurs had 2 nutrient arteries and 40% of them had only 1 nutrient artery. The superior artery had the dominant function. The medullary foramina were at the super medial point of femur and middle point of femur.The nutrient artery divided into ascending and descending branches after perforating into the medullary space and run along the back wall of medullary space tightly. All IM vessels could be damaged by IM reaming. Conclusion: The main branches of IM vessels injury could be avoid by not reaming. The gap of the IM nailing should be firected to the posterior of medullary cavity (175°～182°).The periosteum near linea aspera should not be stripped during operation on super medial femur fracture to avoid damage on superior nutrient artery.