髋关节外科脱位入路应用解剖学测量

发布时间：2018-10-16 21:15

【摘要】：[目的]国外虽然有髋关节外科脱位入路应用解剖学测量,但国内尚无髋关节外科脱位入路应用解剖学测量文献。此次实验为国内首次髋关节应用解剖学测量,一方面用以比较国内外测量结果有无差异性,另一方面为髋关节外科脱位入路提供更为丰富的解剖学依据。[方法]选择5具(10侧髋部)新鲜尸体(男2,女3),4具新鲜尸体标本经颈总动脉注入稀释肝素钠后,待血管内血栓充分溶解后,经颈总动脉回抽至无法抽出液体。经颈总动脉注入染色聚氯乙烯200-300ml,待聚氯乙烯充分聚合后,侧卧位(方便解剖测量)按髋关节外科脱位入路行相关解剖学测量。观测的内容:(1)分别测量闭孔外肌、闭孔内肌水平处,旋股内侧动脉距离转子间嵴的距离,测量旋股内侧动脉距离小转子之间的距离。(2)观察并记录旋股内侧动脉在股骨后方走形特点,以及旋股内侧动脉深支进入髋关节关节囊后在股骨颈上走形特点。(3)观测旋股内侧动脉与臀下动脉分支所形成吻合血管支的特点。[结果](1)旋股内侧动脉距离小转子平均距离17.20±2.25mm,旋股内侧动脉在闭孔外肌水平距离转子间嵴平均距离6.60±1.43mm,旋股内侧动脉在闭孔内肌水平距离转子间嵴平均距离11.30±1.70mm。(2)在股骨颈后上方旋股内侧动脉深支进入关节囊,股骨颈上终末血管支行走顺时针范围10:00至12:30。股骨颈下终末血管支行走顺时针范围5:00至6:30。股骨颈上终末血管支进入滋养孔的位置距离关节边缘:平均4.5mm(范围3-10mm)。[结论](1)大转子支是手术中确认旋股内侧动脉深支重要的解剖学标志。(2)股方肌上端、下[V肌下端的旋股内侧动脉即距离转子间嵴6.60±1.43mm以内及股骨颈后上方及稍前方属危险区域。(3)臀下动脉分支与旋股内侧动脉深支所形成的吻合血管支对于股骨头血液供应至关重要。
[Abstract]:Objective: although there are applied anatomical measurement of dislocation approach in hip surgery abroad, there is no literature on applied anatomy measurement of surgical dislocation approach of hip joint in China. This experiment is the first applied anatomical measurement of hip joint in China. On the one hand, it is used to compare the results of measurement at home and abroad, and on the other hand, it provides more anatomical basis for the surgical dislocation approach of hip joint. [methods] five (10 hips) fresh cadavers (male 2, female 3) were selected. 4 fresh cadavers were injected with diluted heparin sodium via common carotid artery. The coloring PVC 200-300 ml was injected into the common carotid artery. After the PVC was fully polymerized, the lateral position (convenient anatomical measurement) was measured according to the surgical dislocation approach of the hip joint. The contents of the observations were as follows: (1) the distance between the medial circumflex femoral artery and the intertrochanteric crest was measured at the level of the external obturator muscle, the internal obturator muscle, and the medial circumflex femoral artery. The distance between medial circumflex femoral artery and small trochanter was measured. (2) observing and recording the shape of medial circumflex femoral artery in the posterior femur. And the shape of the deep branch of medial circumflex femoral artery on the femoral neck after entering into the hip joint capsule. (3) the characteristics of anastomosing branches of medial circumflex femoral artery and inferior gluteal artery were observed. [results] (1) the average distance between medial circumflex femoral artery and trochanter was 17.20 卤2.25mm, the average distance between medial circumflex femoral artery and intertrochanteric crest was 6.60 卤1.43mm, and that of medial circumflex femoral artery was 11.30 卤1.70mm. The deep branch of the medial circumflex femoral artery above the neck of the bone enters the articular capsule. The terminal branch of the femoral neck runs clockwise from 10:00 to 12: 30. The subfemoral neck terminal branch runs clockwise from 5:00 to 6: 30. The superior femoral neck end vessel branch enters the trophoblastic foramen from the edge of the joint: average 4.5mm (range 3-10mm). [conclusion] (1) the greater trochanter branch is an important anatomic marker for the recognition of the deep branch of medial circumflex femoral artery. (2) the upper end of the quadratus femoris muscle. The medial circumflex femoral artery at the lower end of the V muscle is within 6.60 卤1.43mm of the intertrochanteric crest and above and slightly anterior to the posterior femoral neck. (3) the anastomotic branch of the inferior gluteal artery and the deep branch of the medial femoral circumflex artery is essential to the blood supply of the femoral head.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4;R322

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