股骨头缺血性坏死导管介入溶通治疗的临床观察

Observation of interventional therapy for avascular necrosis of the femoral head

目的:探讨股骨头缺血性坏死(ANFH)的DSA表现及介入治疗效果。方法:对38例ANFH患者的53髋先常规行股动脉DSA,后在股骨头的供血动脉旋股内、外侧动脉内灌注溶栓、扩血管药物,即在每支血管内注入稀释后的尿激酶20万u、丹参10ml及川芎嗪20mg;术后保留导管于动脉内,经导管每日注入同剂量的药物及肝素钠4500u,连用3天后拔管,治疗后复行股动脉DSA检查及行股骨头X线平片及/或CT、MR随访以评估疗效。结果:术后DSA示治疗后所有患者股骨头区血管计数较治疗前增多(P<0.05),患者患髋疼痛症状明显减轻,关节功能不同程度改善,股骨头X线平片及/或CT、MR随访1～16个月(平均9.5个月)示FicatⅠ、Ⅱ期患者介入治疗后股骨头修复明显。结论:ANFH行股骨头供血动脉内的介入治疗是一种疗效肯定、安全的方法。

Objective To study the angiography changes and evaluate the effects of the avascular necrosis of femoral head （ANFH） by selective digital subtraction angiography（DSA）.Methods 38 cases with 53 hips of ANFH were treated with the method of thrombolysis and opening catheterizing and perfusing medial and lateral circum- flex arteries.Those drugs were Urokinase 200 thousand Units,Danshen Root 20 ml and Ligustrazine 20 mg. Retention catheter was held in the target vessels and infused the same drugs besides Heparin 4500u in 3 days. To evaluate therapeutic effect ,the DSA of the femoral artery and x-ray plain film and/or CT/MRI of the femoral head were preformed. Results All cases were followed up for 1-16 （mean 9.5） months.DSA of the cases demonstrated an increased in vessel count in the region of femoral head after treatment as compared with that before treatment（P〈0.05）. Disorders of joint function were improved in some degree. Hip pain was alleviated significantly in all patients after treatment. Osteonecrosis of femoral head was repaired for Ficat Ⅰ, Ⅱ after treatment ,which was showed by x-ray,CT or MRI.Conclusion The angiography changes in ANFH are complex.It is likely that multifactors play a role in the development of ANFH .Interventional therapy has an improving effect for the blood supply of the femoral head,which is a safe method with exact therapeutic effects.