股骨头缺血性坏死的介入治疗(附50例分析)

Interventional treatment for the ischemic necrosis of femoral head

目的：探讨股骨头缺血性坏死介入治疗的方法、疗效及术后康复治疗的措施。方法：股骨头缺血性坏死50例,单侧20例,双侧30例。采用Seldinger技术,对患侧的髂内动脉、旋股内动脉及旋股外动脉插管后,经导管灌注前列腺素E1、尿激酶和复方丹参注射液进行治疗。经导管灌注治疗2次者35例,3次者15例。术后康复治疗生活指导24-36个月,运用CR摄片及螺旋CT扫描及临床表现评价治疗效果。结果：50例患者临床症状均有明显改善。单侧20例股骨头缺血性坏死经介入治疗及术后康复治疗24-36个月,经CT扫描及CR摄片复查,病变稳定12例,明显好转8例;双侧患病的30例中,治疗后病变稳定16例,明显好转14例,总有效率100/%,其中稳定56/%（28/50）,明显好转44/%（22/50）。结论：股骨头缺血性坏死介入治疗是一种安全有效的方法,术后康复指导是确保取得治疗效果的必要措施。

Objective： To explore the curative effect of interventional treatment and the measure of postoperative rehabilitation care for the ischemic necrosis of femoral head. Methods： 20 cases with the unilateral ischemic necrosis of femoral head and another 30 cases are bilateral. By applying Seldinger＇ s technique, the catheter was guided into bilateral internal iliac artery, circumflex femoris medialis and lateralis and infused with prostaglandin El, uroklnase and complex ＇ Danshen zhusheye＇ to perform the interventional treatment. 35 cases are twice and 15 cases are thrice treatment. After postoperative rehabilitation care and living direction for 24 - 36 months, combined CR photograph, spiral CT scanning and the clinical manifestation to evaluate therapeutic efficacy. Results： The clinical manifestation of all 50 cases got obviously improvement. After interventional treatment and postoperative rehabilitation care for 24 - 36 months, 12 of 20 unilateral cases kept stable condition, the other 8 got obviously improvement; 16 of the 30 bilateral cases kept stable condition, the other 14 got obviously improvement, the total effective rate is I00%, the stable condition 56% （28/50） and the obviousiy improvement 44% （22/ 50）. Conclusion： Interventional treatment for the ischemic necrosis of femoral head is safe and effective, postoperative rehabilitation care and living direction are the necessary measurement to ensure the therapeutic efficacy.