通过冰鲜标本进行解剖学研究并结合数字剪影血管造影（DSA）观察股骨头后上支持带动脉的来源，为治疗股骨头坏死（ONFH）治疗提供指导。

采用10具没有髋关节疾病的冰鲜标本进行股骨头周围血供解剖，观察后上支持带动脉的来源以及走形。回顾性分析2020年至2024年因ONFH收入联勤保障部队第九二〇医院骨科的患者，年龄18~45岁，术前接受DSA确认后上支持带动脉存在并显影。排除标准：类风湿性关节炎、强直性脊柱炎、身体情况不耐受手术、术后依从性差。共计194例符合入选标准，男性120例，女性74例；左髋84例，右髋110例；根据国际骨循环协会（ARCO）分期：Ⅱ期患者128例，Ⅲ期患者66例。髋关节均存在轴向叩击痛，“4”字实验（+）以及不同程度的活动受限。术前行股骨头DSA检查，观察后上支持带动脉的来源，以此指导手术方式的选择。评估患者术前术后的Harris 髋关节功能评分、视觉模拟疼痛评分（VAS）及关节活动情况等，数据采用配对样本t检验进行分析。

10具冰鲜标本后上支持带动脉均存在，7具标本（70%）来源于旋股内侧动脉，3具标本（30%）来源于臀下动脉。194例患者均完成术前DSA检查，156例（79.9%）来源于旋股内侧动脉；39例（20.1%）来源于臀下动脉。39名臀下动脉型（ARCO Ⅱ期30例，ARCO Ⅲ期9例）患者均获得随访，随访时间为6~48个月，平均随访（20.1±0.6）个月。ARCOⅡ期患者病情无进一步进展，ARCOⅢ期患者有1例股骨头塌陷，但其髋关节疼痛术后较术前明显减轻，活动度有所改善。其余患者股骨头表面无塌陷，关节间隙与髋关节屈伸活动功能都尚可。术后12个月随访时，VAS评分（2.4±1.2）分，Harris评分（92.7±1.3）分，均较术前有明显改善（t=4.74、33.54，均为P<0.001）。

后上支持带动脉大部分由旋股内侧动脉发出，小部分由臀下动脉发出。臀下动脉型较旋股内侧动脉性走行位置较高，保髋手术方式更多，创伤及医源性损伤血管风险更低，但需更多病例进一步观察。

To combine anatomic structure study of specimen and the digital subtraction angiography (DSA) on the origination of posterior-superior retinaculum artery, so as to provide guidance for the treatment of femoral head necrosis (ONFH).

The blood supply around the femoral head was dissected in 10 fresh frozen specimens without hip diseases to observe the origin and shape of the posterior-superior retinaculum artery. The patients with ONFH admitted to the department of orthopedics in 920th Hospital of the Joint Logistics Support Force from 2020 to 2024 were retrospectively analyzed, who aged from 18 to 45 years, and accepted DSA before surgery verifying posterior-superior retinaculum artery existence. Exclusion criteria: rheumatoid arthritis, ankylosing spondylitis, physical condition not suitable for surgery , poor compliance after surgery. A total of 194 cases were enrolled, 120 cases of male, female 74 cases. Eighty-four cases involved in left hip and 110 cases involved in right hip. According to Association Circulation Osseous (ARCO) staging, 128 patients were in stage Ⅱ and 66 patients were in stage Ⅲ. All the patients had axial percussion pain, Fabere test (+) and different degrees of motion limitation. After preoperative DSA for femoral head was performed to observe the origination of posterior superior retinaculum artery and to guide the choice of operation method. Harris hip function score, visual analogue scale (VAS) and range of motion of hip were evaluated before and after surgery. The data were analyzed by paired sample t test.

The superior-posterior retinaculum artery presented in all the 10 chilled specimens. Seven specimens (70%) were originated from the medial circumflex femoral artery and three specimens (30%)were from the inferior gluteal artery. The preoperative DSA examination was completed in all 194 cases, illustrating that the posterior-superior retinaculum artery in 156 cases (79.9%) were from the medial femoral circumflex artery, while it originated from inferior gluteal artery in 39 cases (20.1%). Thirty-nine patients with inferior gluteal artery type (30 cases in ARCO stage Ⅱ and nine cases in ARCO stage Ⅲ) were followed up for six to 48 months, with an average of (20.1±0.6) months. The patients in ARCO stageⅡshowed no further progress. One patient in ARCO stage Ⅲ occurred femoral head collapse, but the hip pain was remarkably relieved after the surgery compared with the preoperative condition, and the range of motion of hip also improved. The other patients had no collapse of the femoral head surface, showing good joint space, and good hip flexion and extension function. At 12 months after surgery , VAS score was (2.4±1.2), Harris score was (92.7±1.3), all obviously improved when compared with the preoperative data (t = 4.74, 33.54, both P< 0.001).

Most of the posterior-superior retinaculum arteries originate from the medial circumflex femoral artery, and a small part are from the inferior gluteal artery. Compared with the medial circumflex femoral artery type, the inferior gluteal artery type has a higher anatomical position, more alternative surgical methods of hip preservation may be applied with lower risk of trauma and iatrogenic vascular injury, but further observation of more cases are needed.