股骨头缺血性坏死介入治疗的临床应用

Clinical application of interventional therapy for avascular necrosis of the femeral head

目的 评价股骨头缺血性坏死介入治疗的可行性 ,介绍与文献报道治疗方法的不同之处。方法 将扩张血管、溶栓及改善微循环的药物直接注入缺血坏死股骨头的供血动脉旋股内、外动脉。注入药物前 ,大腿根部用加压止血带捆绑并加压。 4 5d后重复治疗。治疗后第 15天 ,患肢静滴尿激酶 10万U d ,共 10d。治疗前后临床症状及影像学表现对比研究。结果 介入治疗后疼痛的缓解或改善占10 0 % ,X线、CT复查均有不同程度的骨质修复 ,新骨形成。DSA显示股骨头供血小动脉增粗 ,细小动脉增多 ,显影时间缩短。 4级骨质改善轻微或不明显。结论 介入插管治疗股骨头缺血性坏死 ,尤其是 3级以前患者是一种安全有效的治疗方法。

Objective To evaluate the possibility of interventional therapy for avascular necrosis of the femeral head, with different curing methods, way of introduction and cultural heritages. Methods Vasodilator, thrombolytics and promoting microcirculatory drug were directly injected into the feeding arteries of the avascular necrotic femoral heads, under the condition of applying the blood stoppage belt at the root of thigh with pressure before the drug injection into the femoral pronator and extension arteries. The treatment was repeated 45 d later. Urokinase 10 5 unite/d ×10 were administrated with venous infusion ipsilaterally on the 15th day after the beginning of the therapy. Imaging features and clinical symptoms were recorded and correlatively studied before and after the treament. Results Symptoms relief especially the pain reached 100% after the treatment with various degrees of bony repair and new bone formation. Furthermore, increase caliber of feeding small arteries for femoral head and multiplicity of microvasculature, shortening of opacification time were revealed by DSA. IV stage bony change showed mild or inconspicuous. Conclusions Interventional catheterization treatment for avascular femoral head necrosis, especially the patients of fore Ⅲ stage, is safe and effective.