股骨头缺血性坏死的介入治疗研究

The investigation on interventional therapy for avascular necrosis of femoral head

目的研究介入治疗对股骨头缺血性坏死的疗效及其应用价值。方法采用Hungerford分期,筛选经临床和影像学确诊为股骨头缺血性坏死患者48例(68髋),采用超选择灌注扩血管溶栓术,将导管插入患髋旋股内、外动脉及髂内动脉注入扩管溶栓药物。治疗前后6个月分别进行患髋关节功能评分。结果0-Ⅱ期有42髋,术前及术后6个月的评分有统计学差异。Ⅲ-Ⅳ期有26髋,治疗前后无统计学差异。介入治疗后,41例(83%)髂外动脉造影显示旋股内、外动脉的分支血管轮廓不同程度增粗且分支数目增加;44例(占91%)患者髋关节疼痛、功能障碍等不适得到缓解或消失。治疗后X线、CT、MRI复查坏死骨质均有不同程度的新骨形成及修复。结论髂外动脉灌注溶栓、扩血管药物能有效增加股骨头和关节的供血。介入治疗对0-Ⅱ期患者,能够延缓病变的发展,避免或延迟行髋关节置换术。对Ⅲ期、Ⅳ期患者,只能作为姑息疗法,缓解髋关节疼痛症状。

Objective To evaluate the effect and value of the interventional therapy for avascular necrosis of the femoral head （AN- FH）. Methods According to Hungerford staging of ANFH, 48 patients with ANFH （68 hips） were analyzed by clinic and imageology. The interventional therapy was performed by superselective infusion of fibrinolysis and dilated medical treatment, and then catheter was inserted super selectively into medial femoral circumflex artery, and lateral femoral circumflex artery and lateral iliac artery. The results were evaluated before and after operation with hips function. Results 42 hips of 0 - Ⅱ stages were analyzed; there were significant difference between before operation and six months after operation. 26 hips of Ⅲ-Ⅳ stages were analyzed, there were not significant difference between before operation and six months. After interventional therapy, 41 （83%） patients showed significant changes of vessels in DSA on the affected side as compared with those before treatment; the lateral and medial circumflex femoral arteries showed an increase in the number and caliber of branches with marked extension of superior and inferior branches to the area of femoral head, pains and dysfimctions of 44 （91%） patients＇ hip joints relieved or disappeared. X- ray, CT or MRI showed that the recovery of necrotic bone and formation of new bone in different degree was found. Conclusion Iliac external arteriae infusion of fibrinolysis and dilated medical treatment can efficiently increase caput femoris and physiological blood- supplied. Interventional therapy for ANFH Ⅰ and Ⅱ stages, the total arthroplasty can be avoided or delayed.