旋股内侧动脉解剖在股骨颈骨折患者临床疗效中的评估意义

[摘要]目的 评估旋股内侧动脉（MFCA）的解剖结构对股骨颈骨折内固定术后股骨头血运的影响及临床疗效分析。方法 回顾性分析苏州大学附属太仓医院2014年1月至2019年1月收治的股骨颈骨折患者，筛选其中行超选数字减影血管造影（DSA）检查并最终行内固定治疗的患者共81例，根据旋股内侧动脉的起源分为股深动脉组（65例）和股动脉组（16例），比较两组旋股内侧动脉开口处内径及流速，分析两组手术时间、复位质量、骨折愈合时间、末次髋关节功能Harris评分及并发症发生情况，对比分析MFCA不同解剖结构对影像学及临床结果的影响。结果 本组共纳入行内固定治疗股骨颈骨折患者81例，所有患者均已行DSA检查，按照旋股内侧动脉解剖起源分为股深动脉组和股动脉组。两组患者在性别、年龄、骨折类型组成以及血流动力学数据方面均无显著差异。所有患者获得18 ～ 23（19.26±4.17）个月的随访，均获得骨折愈合，截至末次随访，股深动脉组有5例发生股骨头坏死，股动脉组有2例发生股骨头坏死。股深动脉组患者平均手术时间（37.81±12.44）min，股动脉组平均手术时间（34.35±10.49）min；股深动脉组复位质量优44例，良18例，可3例；股动脉组复位质量优12例，良3例，可1例；股深动脉组骨折愈合时间为（17.63±6.26）周，股动脉组骨折愈合时间为（18.02±4.79）周；股深动脉组患者末次随访平均Harris评分（85.74±7.06）分，股动脉组患者末次随访平均Harris评分（82.03±6.19）分。术后所有指标比较，差异均无统计学意义。结论 旋股内侧动脉解剖起源存在变异，但是其在血流动力学方面无明显差异，对股骨颈骨折内固定治疗的疗效及总体预后无显著影响。

Clinical significance of medial femoral circumflex artery anatomy in patients with femoral neck fracture

[Abstract]Objective To evaluate the effect of anatomy of medial femoral circumflex artery on femoral head blood supply after internal fixation of femoral neck fracture and analyze its clinical efficacy. Methods The patients with femoral neck fracture treated in Taicang Affiliated Hospital of Suzhou University from January 2014 to January 2019 were retrospectively analyzed. The patients who underwent digital subtraction angiography (DSA) examination and internal fixation were selected. According to the origin of medial circumflex femoral artery, a total of 81 cases were included and divided into deep femoral artery group and femoral artery group. The diameter and flow velocity of medial circumflex femoral artery were compared, and the operation time, reduction quality, fracture healing time, Harris score at the last follow-up and the incidence of complications were compared to analyze the influence of different anatomy of MFCA on imaging and clinical results. Results According to the anatomical origin of medial circumflex femoral artery, 81 patients were divided into deep femoral artery type and femoral artery type. There were no significant differences in gender, age, fracture type and hemodynamic data between the two groups. All patients were followed up for 18-23 months, and fracture healing was achieved. Up to the last follow-up, there were 5 cases of femoral head necrosis in deep femoral artery group and 2 cases in femoral artery group. The average operation time of deep femoral artery group was (37.81±12.44) min, the average operation time of femoral artery group was (34.35±10.49) min. In deep femoral artery group, the reduction quality was excellent in 44 cases, good in 18 cases and fair in 3 cases. In femoral artery group, the reduction quality was excellent in 12 cases, good in 3 cases and fair in 1 case. The healing time of deep femoral artery group was (17.63±6.26) weeks, the fracture healing time of femoral artery group was (18.02±4.79) weeks. The last average Harris score of deep femoral artery group was (85.74±7.06), the last average Harris score of femoral artery group was (82.03±6.19). There was no significant difference in all indexes after operation. Conclusion The anatomic origin of medial circumflex femoral artery varies, but there is no significant difference in hemodynamics. It has no significant effect on the curative effect and overall prognosis of internal fixation for femoral neck fracture.