股骨头颈骨内、外静脉回流的解剖学研究

目的 :为探讨Legg Perthes病的发病机理及临床治疗提供形态学依据。 方法 :采用巨微解剖、血管透明、组织切片、造影、扫描电镜等方法对 45例胎儿、新生儿及儿童的股骨头颈骨内、外静脉回流途径、骨内微血管构筑特点进行观察。结果 :(1 )髋关节骨外静脉包括 :旋股内、外侧静脉 ,闭孔静脉 ,臀上、下静脉 ,颈后静脉 ,髂腰静脉 ,股骨头韧带静脉 ,颈升静脉 ;骨内静脉包括 :前、后、上、下骺静脉 ,内骺静脉 ,前、后、上、下干骺静脉。关节囊内存在丰富的滑膜下静脉网 ,髋关节周围形成两个彼此有吻合的环状结构。(2 )一条微动脉一般有两条微静脉伴行 ,微静脉间有丰富的横行吻合支 ,在微动脉移行为毛细血管的部位 ,常可见到环形缩窄。结论 :(1 )Legg Perthes病与股骨头、颈静脉回流障碍密切相关。 (2 )根据股骨头、颈骨内外静脉回流特点 ,Legg Perthes病可以设计骨内、外双重介入治疗 ,骨内、囊内静脉搭桥的显微外科治疗方案

Anatomy of the intra- and extra-osteal venous drainage in femoral head and neck

Objective: To probe into the mechanism of the Legg Perthes disease and provide morphological basis for its clinical treatment. Methods: The venous drainage and the distributional characteristics of intra and extraosteal capillary of femoral head and neck were observed in 45 fresh cadaveric specimens (including fetuse 30, neonate 13 and child 2). The methods used in this study were as follows: microdissection, hyaline vessel specimens, histological slice, radiography and scanning electron microscope. Results: (1) The extra osteal veins in hip joint included medial and lateral femoral circumflex vein, obturator vein, superior and inferior gluteal vein, posterior cervical vein and iliolumbar vein, ligament vein of femoral head and ascending cervical vein.Intra osteal veins in the hip joint included anterior, posterior, superior, inferior and medial epiphyseal vein and anterior, posterior, superior and inferior metaphysis vein.(2) One arterioloe was accompanied by two venules, and there were rich transversal anastomosis branches among these venules. Ring strictures were found at the boundary zone between arteriole and capillary. Conclusions: (1) Legg Perthes disease correlates with venous drainage obstruction of femoral head and cervix.(2) According to the characteristics of the venous drainage of the femoral heat and cervix, we can design microsurgically therapeutic plans for Legg Perthes disease through intra and extra osteal interventional therapy or building bridges between intra osteal veins and intracapsular veins.