Assessment of trochanteric vascularity using quantitative magnetic resonance imaging in a cadaveric model

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-11-14 DOI:10.1002/jeo2.70092

Craig E. Klinger, Burak Altintas, Kathryn A. Barth, Kenneth M. Lin, David C. Dewar, Lionel E. Lazaro, Jonathan P. Dyke, David S. Wellman, David L. Helfet

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Abstract

Purpose

Few studies have assessed trochanteric vascularity despite its implications for bone healing and surgical approaches. This study aimed to assess the regional arterial contributions of the medial femoral circumflex artery (MFCA) versus the lateral femoral circumflex artery (LFCA) to trochanteric vascularity.

Methods

Ten adult human cadaveric pelvises to mid-femur specimens were obtained. One hip was randomly assigned experimental (either MFCA or LFCA MRI-contrast infusion) and contralateral as control (MFCA and LFCA magnetic resonance imaging [MRI]-contrast infusion). Vascular dissection was performed for MFCA and LFCA cannulation. Pre- and post-contrast 3T MRI was completed, and intra-osseous contributions were quantified by region: greater trochanter (GT), intertrochanteric (IT), lesser trochanter (LT) and subtrochanteric (ST). A polyurethane compound mixed with barium sulfate was injected into the LFCA cannula, and into the MFCA cannula for the contralateral hip. Computed tomography (CT) imaging was completed to assess terminal branch locations.

Results

MFCA provided the majority of arterial contributions to the full trochanteric region (68.5% MFCA, 31.5% LFCA; standard deviation [SD]: 10.7%, p < 0.001). Over 70% of arterial contributions to ST, LT and IT regions are derived from MFCA. GT contributions were more balanced (52.5% MFCA, 47.5% LFCA; SD: 33.7%; p = 0.853). Significant differences were found between MFCA and LFCA contributions in all regions except for the GT. CT revealed multiple consistent MFCA and LFCA trochanteric terminal branches.

Conclusions

MFCA provided the dominant trochanteric arterial supply, which highlights MFCA's importance to overall hip vascularity. LFCA's trochanteric contribution was smaller but still provided trochanteric contributions, especially the GT region. Knowledge of trochanteric arterial contributions can be beneficial for optimizing surgical approaches and fixation to protect terminal branches during trochanteric fracture, nonunion treatment and trochanteric osteotomies.

Level of Evidence

Not applicable.

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在尸体模型中使用定量磁共振成像评估转子血管情况

目的尽管转子血管对骨愈合和手术方法有影响，但很少有研究对其进行评估。本研究旨在评估股内侧周动脉（MFCA）和股外侧周动脉（LFCA）对转子血管的区域贡献。方法取来十个成年人类尸体骨盆到股骨中段标本。随机分配一个髋关节为实验组（MFCA 或 LFCA 磁共振成像对比输注），对侧为对照组（MFCA 和 LFCA 磁共振成像对比输注）。在 MFCA 和 LFCA 插管时进行血管解剖。完成对比前和对比后 3T 磁共振成像，并按区域量化骨内贡献：大转子（GT）、转子间（IT）、小转子（LT）和转子下（ST）。在 LFCA 插管和对侧髋关节的 MFCA 插管中分别注入与硫酸钡混合的聚氨酯化合物。完成计算机断层扫描（CT）成像以评估终末分支位置。结果 MFCA 为全转子区域提供了大部分动脉供血（68.5% MFCA，31.5% LFCA；标准差 [SD]：10.7%，P < 0.001）。超过 70% 的 ST、LT 和 IT 区域动脉供血来自 MFCA。GT 的贡献更为均衡（52.5% MFCA，47.5% LFCA；SD：33.7%；P = 0.853）。除 GT 外，MFCA 和 LFCA 对所有区域的贡献均存在显著差异。CT 显示多个一致的 MFCA 和 LFCA 转子末端分支。结论 MFCA 提供了主要的转子动脉供应，这凸显了 MFCA 对整个髋部血管的重要性。LFCA 对转子的贡献较小，但仍能提供转子，尤其是 GT 区域。了解转子动脉的贡献有助于优化手术方法和固定方式，从而在转子骨折、不愈合治疗和转子截骨时保护末端分支。证据级别不适用。

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