股骨颈支持带的解剖学研究及临床意义

Anatomic study and clinical significance of the retinacula of femoral neck

目的探讨股骨颈支持带的形态结构特点,为临床股骨颈的安全显露提供解剖学依据。方法取新鲜下肢标本4例、红色乳胶灌注固定标本60例,通过显微解剖、铸型标本和股骨颈支持带切片等方法研究股骨颈支持带的位置、形态、分布及中段宽度等。结果 (1)3条支持带的形态结构特点:上支持带出现率100%,恒定出现,走行在11:00～13:00位置,此支持带变异最小;下支持带出现率为100%,走行在06:00～07:30位置,在3条支持带中它最为坚韧;前支持带出现率为60%,变异最大,走行在02:30～04:00位置。(2)组织切片显微镜观察发现血管贯穿于支持带,上、下支持带均有血管、神经支配。(3)股骨颈安全显露的区域:08:00～10:00的位置,此处支持带较少出现。结论上、下支持带恒定出现,走行位置较为恒定,且富含血管、神经,是股骨头血供的重要来源,同时经大转子后内侧切开显露股骨颈,操作更安全、方便。

Objective To explore anatomic features ofretinacula of femoral neck, and provide anatomic basis for clinic application. Methods 4 fresh lower limb specimens and 60 adult lower limb specimens injected arterially with red emulsion were collected. The position, course, shape, distribution and the width of middle part of retinacula were dissected and analyzed. Results The upper retinaculum, which was found in all specimens, and without anatomic variation, located from 11 o＇clock to 1 o＇clock position. The lower retinaculum, which was also found in all specimens, located from 6 o＇clock to7 and a half o＇clock. This retinacula was the strongest one among three retinaculum. The anterior retinaculum, which was only found in 60% specimens, located from 2 and a half o＇clock to 4 o＇clock position. Anatomic variation of the anterior one was common. Histological examination revealed that the blood vessel passed through the retinaculum, and mainly distributed to both of upper and lower retinaculum, followed by nerve distribution. For exposing femoral neck safely, the best site was from 8 o＇clock to 10 o＇clock position, where was absent for retinaculum. Conclusions The upper and the lower retinaculum have abundant blood supply and nerve innervation, with the stable distribution, which are the important source of femoral neck＇s blood supply. The surgical operation will be more safely and convenient through an posteromedial incision of the greater trochanter.