股骨头修复与重建术后血运重建的数字减影血管造影评价

Evaluation of hemodynamic changes by digital subtraction angiography after treatment of avascular osteonecrosis of femoral head with vascularized bone flaps

目的 评估股骨头缺血性坏死（ONFH）带血管蒂骨瓣转移治疗前后股骨头内血运变化情况对疗效的影响。方法 54例单侧股骨头缺血性坏死保存股骨头治疗的患者于术前及术后6周进行股动脉插管通过数字减影血管造影（DSA）检查，按ARCO分期标准Ⅱ期33髋，Ⅲ期21髋。治疗方法分别为带旋股外血管升支髂骨瓣转移术23侧，带旋股外侧动脉升支臀中肌支大转子骨瓣13侧，带旋股外血管横支大转子骨瓣转移术9例，带旋股外侧动脉升支臀中肌支、横支大转子支双血管蒂大转子骨瓣9例。其中19例患者在术后6～24个月再次行患髋DSA复查。结果 54例术前股动脉DSA造影均显示股骨头供血的异常改变。术后6周DSA显示48侧转移骨瓣血管蒂充盈良好，股骨头内供血明显改善；6例术后DSA显示转移骨瓣血管蒂充盈不佳或股骨头内无造影剂充盈，其中1例术后8个月复查DSA显示血管蒂充盈满意，股骨头血供良好。本组病例临床成功率为91％，影像学成功率为85％。结论 保证转移骨瓣血管蒂通畅是ONFH保头治疗成功的关键。

Objective To evaluate the effect of digital subtraction angiography （DSA） in evaluation of the hemodynamic changes after treatment of avascular osteonecrosis of femoral head with vascularized bone flaps. Methods Fifty-four patients, 33 males and 21 females, 33 hips being at the stage II and 21 hips being at the stage Ul, were treated with vascularized bone flaps, including iliac bone flaps pedicled with ascending branch of lateral femoral circumflex artery for 23 hips, greater trochanter bone flaps pedicled with gluteal muscle branch of ascending branch of lateral femoral circumflex artery for 13 hips, greater trochanter bone flaps pedicled with transverse branch of ascending branch of lateral femoral circumflex artery for 9 hips, and greater trochanter bone flaps pedicled with gluteal muscle branch and transverse branch of ascending branch of lateral femoral circumflex artery for 9 hips. Selective DSA was performed on all 54 patients preoperatively and on 19 patients 6 N 24 months post-operatively, Results DSA before operation demonstrated abnormal vascularization in all 54 patients. Six months after operation reconstruction of blood supply on the femoral head was seen in 48 cases. Six patients showed poor filling or failure of filling of the vessel pedicles in transplanted bone flaps 6 months post-operatively and DSA conducted 8 months postoperatively showed satisfactory filling in one of the 6 cases. The clinical success rate of this group was 91%, and the radiological success rate was 85%. Conclusion Selective DSA is effective in evaluation of the postoperative hemodynamic changes in the necrotic femoral head. Significant blood supply in the bone flap is the key point in the success of treatment of ONFH.