股骨头颈部血供的三维全景图制作及临床意义

Developing three dimensional visualization of blood supply to the femoral head

关键词:  股骨头  血供  支持带动脉  计算机  股骨颈骨折  三维全景图

Key words:  femoral head  blood supply  retinacula of Weitbrecht  computer technology  femoral neck fracture  three dimensional visualization

摘要:

目的 建立股骨头颈部血供的三维全景图,以利于临床医师直观理解股骨头颈部的血供特点,为相关临床诊疗提供决策参考。方法 对6个新鲜髋部标本,28个福尔马林固定髋部标本进行解剖学观察,然后在通过计算机断层扫描等方法获取医学图像的基础上,运用计算机软件完成股骨头颈部血供的三维全景图像的制作。结果解剖学观察显示股骨头颈部的血供和相关文献研究类似。圆韧带动脉的供血范围变异较大,极少数可通过骨内血管吻合供给整个股骨头；个别股骨干滋养动脉升支也可供应整个股骨头；旋股内、外侧动脉分出的上、下和前支持带动脉是股骨头颈部最重要的动脉,尤其以上支持带动脉最重要。所制作的股骨头颈部血供的三维全景图可精准显示股骨头颈部骨内外血供的每一处细节,可从任意角度观察股骨头颈部的血供来源和分布。结论 股骨头颈部血供的三维全景图像能准确再现股骨头颈部旋股内、外侧动脉-基底动脉环-支持带动脉三级血供系统的分布、走形、解剖学特点,有利于临床医师对股骨头血供的理解和临床诊疗决策。

Abstract:

Objective To develop three dimensional (3D) visualization of blood supply to the femoral head. Methods Six fresh hip specimens and 28 formalin fixation hip specimens were observed and scanned with CT and micro CT, and the 3D visualization of blood supply to the femoral head was developed with computer software. Results The anatomical observation showed that the range of the blood supply of the ligamentum teres artery varied very much, while few supplied the whole femoral head, additionally some femoral nutrient arteries also supplied the whole femoral head. The blood supply of the femoral head derived primarily from the medial femoral circumflex artery (MFCA) and the lateral femoral circumflex artery (LFCA), however, the largest contributor to that was the superior Weitbrecht's retinacula. The distribution and complex anatomy of the lateral and medial femoral circumflex arteries, arterious circle and the retinacula of Weitbrecht were shown precisely with the 3D visualization. Conclusion The 3D visualization has been developed, and all details of derivation and distribution of blood supply to the femoral head can be reproduced with the developed 3D visualization.