股骨颈骨折后关节囊压力对股骨头血供的影响

Effects of Intraarticular Pressure on Blood Supply of Femoral Head

目的 :研究股骨颈骨折后髋关节囊内压力与股骨头血供的关系。方法 :测定新鲜股骨颈骨折患者的髋关节囊内压力变化。运用髓内造影和数字减影血管造影了解关节囊压力增高时股骨头血供的变化。结果 :髋关节囊压力在骨折后明显升高 ,其中髋关节在伸直内旋位时压力升高最明显 ,屈曲 5 0°时压力下降 ,外旋位与中立位之间无显著差异血管造影显示关节囊压力升高会影响股骨头的动脉灌注和静脉的回流。结论 :传统的骨折复位方法可能加重股骨头的血液循环的损害 ,导致不良的预后。髋关节囊内压力升高是导致股骨头发生缺血性坏死的原因之一。

Objective:To observe the relationship between the blood supply of femoral head and the intraarticular pressure(IAP)of hip after femoral neck fracture.Methods:The IAP of 40 patients with intracapsular femoral neck fracture were measured preoperatively with the hip in different positions.The IAP of both hips were measured in 20 of them.Diagnostic test(intraosseous venography and digital substraction angiography)was used to observe what happened to the blood supply of femoral head,when the authors raise the IAP by means of internal rotation or traction of hip joint.Results:Increased IAP caused by hemarthrosis was found.With internal rotation of the straight leg,all the patients had a further elevation of the intraarticular pressure.But it could be decreased with semi-flexion of the hip.There is no significant difference between the external rotation and the neutral position.The result of angiography showed that high IAP reduced perfusion of the femoral head.Conclusion:The IAP of hip may raise after femoral neck fracture.It can be deduced that reduction maneuvers might interfere with the circulation of the femoral head.So increased IAP may be one reason for the occasional occurrence of avascular necrosis of the femoral head after intracapsular femoral neck fracture.Patients may benefit from capsulotomy or aspiration of hip joint.