股骨头缺血性坏死伴旋股外侧动脉动静脉畸形介入治疗效果和安全性

Interventional therapy for avascular necrosis of the femoral head complicated by arteriovenous malformation of lateral circumflex femoral artery: its efficacy and safety

目的探讨介入手术治疗股骨头缺血性坏死(ANFH)伴旋股外侧动脉(LCFA)动静脉畸形的效果和安全性。方法回顾性分析2016年4月至2021年9月在漳州市中医院接受介入手术治疗的22例ANFH伴LCFA动静脉畸形患者临床资料。先行超选择栓塞动静脉畸形供血动脉LCFA,尔后对股骨头滋养动脉旋股内侧动脉、LCFA及闭孔动脉的主干和主要分支行超选择经导管动脉灌注(TAI)治疗,7~14 d后再次行TAI。比较手术前后股骨头滋养动脉DSA表现、Harris髋关节功能评分及多层螺旋CT(MSCT)影像上股骨头骨质改变。结果所有患者动静脉畸形瘘口均成功封堵,TAI顺利完成,技术成功率为100%。血管造影显示术后LCFA动静脉畸形消失,股骨头滋养动脉明显增多,侧支循环形成。发生异位栓塞8例,均未产生严重后果。随访3~24个月,末次随访Harris髋关节功能评分与第1次手术前相比差异有统计学意义(P<0.05),MSCT检查显示股骨头坏死区病灶稳定,周围骨质增生、边缘硬化及囊变缩小。治疗有效率为100%。结论介入治疗ANFH伴LCFA动静脉畸形微创、安全有效,有助于保留股骨头。

Objective To discuss the therapeutic effect and safety of interventional treatment for avascular necrosis of the femoral head(ANFH)complicated by arteriovenous malformation(AVM)of lateral circumflex femoral artery(LCFA).MethodsThe clinical date of a total of 22 patients with ANFH associated with AVM of LCFA,who received interventional treatment at the Zhangzhou Municipal Hospital of Traditional Chinese Medicine of China between April 2016 and September 2021,were retrospectively analyzed.For all patients,superselective embolization of LCFA,which was the feeding artery of AVM,was carried out,which was followed by superselective transcatheter arterial infusion(TAI)of low-molecular-weight dextran,papaverine,urokinase and 654-2 into the medial circumflex femoral artery(MCFA),which was the nourishing artery of femoral head,LCFA,and the main trunk and major branches of the obturator artery.After 14 days,TAI therapy was repeated.The preoperative and postoperative angiographic findings of the nourishing artery of femoral head on DSA images,the Harris hip function score,and the bone mineral changes of femoral head on multi-slice spiral CT(MSCT)imaging were compared.ResultsSuccessful occlusion of AVM fistula and TAI therapy were accomplished in all the 22 patients,with a technical success rate of 100%.Postoperative angiography showed that the AVM of LCFA disappeared,the number of the nourishing arteries of femoral head was increased,and the newly-developed collateral circulation of femoral head was observed.Ectopic embolization occurred in 8 patients with no serious consequences.The patients were followed up for 3-24 months.The Harris hip function score obtained at the last follow-up visit was significantly different from the preoperative one(P<0.05).MSCT examination indicated that the lesion in the necrotic area of the femoral head was stable and its surrounding bone was hyperplasia with marginal sclerosis and cystic shrinkage.The treatment response rate was 100%.Conclusion For the treatment of ANFH complicated by AVM of LCFA,interventional therapy is minimally-invasive,safe and effective,which helps preserve the femoral head.