中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (36): 5846-5849.doi: 10.3969/j.issn.2095-4344.1898

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

不同体位及牵引质量对股骨颈骨折后髋关节囊内压的影响

刘大海,李海波,苟永胜,李  良   

  1. 成都市双流区第一人民医院骨科,四川省成都市  610200
  • 出版日期:2019-12-28 发布日期:2019-12-28
  • 通讯作者: 苟永胜,硕士,副主任医师,成都市双流区第一人民医院骨科,四川省成都市 610200
  • 作者简介:刘大海,男,1987年生,四川省成都市人,汉族,2016年遵义医学院毕业,硕士,主治医师,主要从事骨与关节方向的研究。
  • 基金资助:

    四川省卫计委重点科研课题(20130537),项目负责人:苟永胜

Effects of different body positions and traction weights on hip bursa pressure after femoral neck fracture

Liu Dahai, Li Haibo, Gou Yongsheng, Li Liang   

  1. Department of Orthopedics, the First People’s Hospital of Chengdu Shuangliu District, Chengdu 610200, Sichuan Province, China
  • Online:2019-12-28 Published:2019-12-28
  • Contact: Gou Yongsheng, Master, Associate chief physician, Department of Orthopedics, the First People’s Hospital of Chengdu Shuangliu District, Chengdu 610200, Sichuan Province, China
  • About author:Liu Dahai, Master, Attending physician, Department of Orthopedics, the First People’s Hospital of Chengdu Shuangliu District, Chengdu 610200, Sichuan Province, China
  • Supported by:
    the Key Scientific Research Project of Sichuan Provincial Commission of Health and Family Planning, No. 20130537 (to GYS)

摘要:

文章快速阅读:
 
  
 
文题释义:
髋关节囊内压:一般与大气压水平相当,远低于股骨头髓内静脉压力。而后者一般为10-20 mm Hg。当髋关节囊内压高于40 mm Hg时,就会影响后上支持带动脉对股骨头的血液灌注。
成人股骨头的血供:①股骨头圆韧带内的小凹动脉:只供应股骨头少量血液,局限于股骨头的凹窝部;②股骨干滋养动脉升支:对股骨颈血液供应很少;③旋股内、外侧动脉的分支(骺外侧动脉):是股骨颈的主要血液供应来源。
 
摘要
背景:在股骨颈骨折的病例中,手术对股骨颈骨折已做到良好复位和固定,但仍有众多患者出现股骨头坏死,这可能与髋关节囊内压影响股骨头血运有关。
目的:探索股骨颈骨折后,不同处理方式对髋关节内囊内压的影响。
方法:于2013年1月至2017年12月,在成都市双流区第一人民医院骨科住院部收集诊断为单纯股骨颈骨折、且Garden分型为Ⅰ-Ⅳ型的120例患者。在下肢不同体位状态下(中立位、内旋30°、外旋30°、外旋50°、外展30°,中立位牵引3-6 kg),测量髋关节囊内压。试验于2013-01-11由成都市双流区第一人民医院医学伦理委员会审批通过。
结果与结论:在患肢不同的体位中,外旋30°时,髋关节的囊内压最小,内旋30°时,髋关节的囊内压最大;在股骨颈骨折不同的分型当中,Garden Ⅲ和Ⅳ型的髋关节囊内压明显高于Garden Ⅰ-Ⅱ型;进行患肢牵引时,随着牵引质量的增加,髋关节囊内压逐渐升高。说明股骨颈骨折后将患肢置于外旋30°、非牵引状态下可明显降低髋关节囊内压。

ORCID: 0000-0002-3378-7159(刘大海)

关键词: 股骨颈骨折, 髋关节, 囊内压, 牵引, 体位, 股骨头坏死, 关节囊, 股骨头缺血

Abstract:

BACKGROUND: In the cases of femoral neck fracture, the surgical reduction and fixation of femoral neck fracture have been well achieved, but there are still many patients with femoral head necrosis, which may be related to the influence of hip bursa pressure on femoral head blood supply.
OBJECTIVE: To investigate the effect of different treatment methods on internal pressure of hip joint capsule after femoral neck fracture.
METHODS: From January 2013 to December 2017, 120 cases diagnosed as simple femoral neck fracture and Garden type I-IV were collected in the Department of Orthopedics, the First People’s Hospital of Chengdu Shuangliu District. The intrathecal pressure of hip joint was measured in different positions of lower limbs (neutral position, internal rotation 30°, external rotation 30°, external rotation 50°, external extension 30°, and neutral position traction of 3-6 kg). This study was approved by the Medical Ethics Committee, the First People’s Hospital of Chengdu Shuangliu District on January 11, 2013.
RESULTS AND CONCLUSION: In different positions of affected limb, the intracapsular pressure of hip joint was the smallest when the external rotation was 30°, and the maximum when the internal rotation was 30°. Among the different types of femoral neck fractures, the internal pressure of hip bursa of Garden type III and IV was significantly higher than that of Garden type I-II. With the increase of traction weight, the pressure in hip capsule increased gradually. It is suggested that placing the affected limb in external rotation of 30° without traction after femoral neck fracture can significantly reduce the internal pressure of hip joint capsule.

Key words: femoral neck fracture, hip joint, capsule inner pressure, traction, position, femoral head necrosis, joint capsule, femoral head ischemia

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