论文部分内容阅读
目的 :为了减少应用髓内针对股骨髓内血供造成的损伤。方法 :观察了 2 0根尸体股骨的髓内血管行径 ,另各用 2根股骨进行扩髓与不扩髓髓内针固定 ,比较其对髓内血管的损伤程度。结果 :①60 %股骨有上、下 2条滋养动脉 ,40 %仅有 1条上滋养动脉 ,其中上滋养动脉为主要动脉。上、下滋养动脉的髓腔进入点 ,分别位于股骨中、上 1/3交界处及中点附近。②滋养动脉进入骨髓腔分成升、降两支髓内动脉 ,其主干均位于髓腔后方并紧贴髓腔壁行走 (仅上滋养动脉的部分远侧分支位于侧壁及前壁 )。③扩大髓腔后 ,髓内血管均被破坏 ,不扩髓腔可保存髓内血管主干。结论 :①应用髓内针时 ,只要能获得可靠的固定 ,不扩大髓腔可以避免损伤髓内血管主干 ;②股骨髓内针开口应指向后侧 ( 175°～ 182°) ;③股骨中、上段骨折手术时 ,应避免剥离近粗线的骨膜 ,以免损伤上滋养动脉。
Objective: To reduce the damage caused by intramedullary injection of intramedullary blood. Methods: The intramedullary vascular pathways of 20 femur were observed. The other 2 femur were used for reaming and non-reamed intramedullary nail fixation. The degree of intramedullary vascular injury was compared. Results: ①60% of the femur had two nourishing arteries on the upper and lower sides, and only one of 40% nourished arteries. Among them, the nourishing artery was the main artery. Upper and lower nourish artery medullary cavity into the point, respectively, located in the femur, 1/3 at the junction and midpoint near. ② nourish the artery into the bone marrow cavity into the ascending and descending two intramedullary arteries, the backbone of which are located in the rear of the medullary cavity and walking close to the medullary canal wall (only part of the distal nodal artery located on the side and distal wall of the distal branch). ③ expand the medullary cavity, intramedullary vascular destruction, non-reamed marrow cavity can be preserved intramedullary vascular trunk. Conclusions: ① When the intramedullary nail is used, the intramedullary vascular stem can be avoided without expanding the medullary cavity as long as it can obtain reliable fixation. ② The opening of femoral intramedullary nail should point to the posterior side (175 ° ~ 182 °) Upper fracture surgery, should be stripped to avoid the thick periosteum, in order to avoid damage to nourish the artery.