股骨头缺血性坏死的介入治疗

Interventional therapy for avascular necrosis of the femoral head

目的:探讨股骨头缺血性坏死(ANFH)介入治疗的效果。方法:对16例ANFH患者的17只髋先常规行股骨头的供血动脉旋股内、外动脉和闭孔动脉造影,继而分别每支血管灌注溶栓、扩血管药物,即在供血动脉内共注入稀释后的尿激酶15～25万u、丹参40ml及低分子右旋糖酐50mg;治疗后复行供血动脉造影检查及行股骨头X线平片及/或CT、MR随访以评估疗效。结果:术后血管造影显示治疗后所有患者股骨头区血管计数较治疗前增多,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1～20个月(平均10.5个月)示FicatⅡ期以内的患者介入治疗后股骨头修复明显。结论:ANFH的血管造影表现是复杂多样的,而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 evaluate the effects of the avascular necrosis of femoral head （ANFH） by selective interventional therapy. Methods 16 cases with 17 hips of ANFH treated with the method of thrombolysis and opening catheterizing and perfusing medial and lateral circumflex arteries.Those drugs are Urokinase 150-250 thousand U- nits, Danshen 40ml and Dextran 50mg.To evaluate therapeutic effect ,the angiography of the femoral artery and xray plain film and/or CT/MRI of the femoral head were performed. Results All cases were followed up for 1-20 （meanl0.5） months. Angiography of the cases demonstrated an increase 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 muhifactor play a role in the development of ANFH. Interventional therapy has an improving effect for the blood supply of the femoral head, and is a safe method with exact therapeutic effects.