应用隐动脉及伴行静脉异位重建股骨头血运的实验研究

Experimental study of heterotopic reconstruction of blood supply of femoral head by saphenous artery and accompanying vein

目的探讨应用猪后肢隐动脉及伴行静脉异位重建股骨头血供的动物实验研究方法。方法选取10头8~10月龄的体质量90~104 kg的普通长白猪,麻醉后构建头下型股骨颈骨折模型,离体后固定于胫骨近端的内侧缘;显微镜下将股骨头内后下支持带动脉同隐动脉分支吻合、前支持带动脉同隐静脉分支吻合以重建股骨头血供;经骨面开窗、数字减影血管造影(DSA)观察术后即时股骨头内血管通血情况;术后7 d观察股骨头钻孔出血情况,记录前支持带动脉、后下支持带动脉外径及隐动脉、隐静脉分支口径。结果前支持带动脉、后下支持带动脉与隐动脉、隐静脉口径基本匹配,可进行血管吻合。经骨面开窗及DSA检查显示异位血管吻合后股骨头内通血明显,术后7 d股骨头钻孔均可见明显的活跃性出血。实验用猪围术期均无明显的不良反应。结论应用猪后肢隐动脉及伴行静脉异位重建股骨头血供效果良好,可提供一种快速、有效、损伤小的实验方法,间接论证通过骨内吻合方法重建股骨颈头下型骨折后股骨头血运存在理论上的可能。

Objective To explore the animal experimental research method of heterotopic reconstruction of blood supply of femoral head by saphenous artery and accompanying vein of porcine posterior limbs.Methods Ten ordinary landrace pig aged 8 to 10 months and weighed 90 to 104 kg were anesthetized to establish subcephalic femoral neck fracture model,which was fixed on the medial edge of the proximal tibia after being separated;the posterior inferior retinacular artery was anastomosed with the branches of the saphenous artery and the anterior retinacular artery was anastomosed with the saphenous vein branches to reconstruct the blood supply of the femoral head under microscope;the fenestration of the bone surface and digital subtraction angiography(DSA)were used to observe the blood flow of the femoral head immediately after operation;the bleeding of the femoral head drilling at 7 days after the operation were observed,and the external diameters of the anterior retinacular artery and posterior inferior retinacular artery as well as the calibers of the saphenous artery and vein branches were recorded.Results The anterior retinacular artery and posterior inferior retinacular artery basically matched the calibers of the saphenous artery and saphenous vein,and vascular anastomosis could be performed.Fenestration through the bone surface and DSA showed that blood flow in the femoral head was obvious after ectopic vascular anastomosis,and there was obvious active bleeding in femoral head drilling at 7 days after operation.There were no obvious perioperative adverse reactions in the experimental pigs.Conclusion Heterotopic reconstruction of blood supply of femoral head by saphenous artery and accompanying vein of porcine posterior limbs shows a good effect,which can provide a fast,effective and less traumatic experimental method,and it can indirectly demonstrate the theoretical possibility of reconstructing the blood supply of the femoral head after subcephalic femoral neck fracture through intraosseous anastomosis.