股骨头坏死及融通术后数字减影血管造影的初步观察

The Image of the Digital Subtraction Angiography(DSA) about Pre-treating and Post-treating of Osteonecrosis of Femoral Head

目的 观察和分析了 39例 (6 4髋 )治疗前后的股骨头坏死的数字减影血管造影 (DSA)的影像学表现。方法 对不同病因、不同分期的股骨头坏死行旋股内动脉插管造影和灌注尿激酶、丹参和川芎嗪。结果 ①股骨头坏死分期与血管造影上下骺动脉分型关系 :股骨头坏死 0期、Ⅰ期和Ⅱ期表现为股骨头内Ⅱ型血管为主 ,Ⅳ型和Ⅴ型血管较少 ;Ⅲ期则Ⅱ型血管减少 ,而Ⅳ型和Ⅴ型血管增多 ;②股骨头坏死不同病因与血管造影上干骺动脉分型关系 :股骨头坏死诱因不同 ,其股骨头内的血管分型也不同 ,创伤性股骨头坏死以Ⅳ型和Ⅴ型为多 ,激素性和酒精性股骨头坏死以Ⅱ型和Ⅲ型为多 ;③股骨头坏死治疗前后与血管造影上干骺动脉分型关系 :治疗前Ⅱ型血管占 2 2 % ,治疗后Ⅱ型血管占 8% ,且Ⅳ、Ⅴ型血管明显增多 ;④股骨头坏死治疗前后与旋股内动脉 /旋股外动脉的血管管径比关系 :股骨头坏死者旋股内动脉扭曲、变细 ,旋股内动脉 /旋股外动脉的血管管径比为 0 6 0± 0 14,经治疗后旋股内动脉增粗 ,旋股内动脉 /旋股外动脉的血管管径比增大为 0 89± 0 2 1。结论 股骨头坏死的发生、发展和股骨头血循环、股骨头骨血管变化有很大的关系 。

Objective Thirty-nine cases(64 hips)of the osteonecrosis of the femoral head were studied on the imaging of the digital subtraction angiography(DSA) before and after treatment.Methods A 5 0F pipe was inserted into medial artery circumflex femora of the patients of osteonecrosis of femoral head for angiography and perfusion of Urokinase,DanSheng and Chuan Xiong qing.Results The vessel in the femoral head was grouped into 5 types on the basis of qualitity of branch of the medial artery circumflex femora.①Relationship of stages of osteonecrosis of the femoral head to types of the vessel of medial artery circumflex femora into femeral head:vessels of type 2 is main,and then type 4 and type 5 is rare on the stage 0、stage 1 and stage 2.type 4 and type 5 is main,and then type 2 is rare on stage 3.②Relationship of inducing factors of osteonecrosis of the femoral head to types of the vessel of medial artery circumflex femora into femeral head:type 4 and type 5 is main in the traumatic factors,type 2 and type 3 vessel is main in the horrnonal and alcoholic factors.③Relationship of treatment of osteonecrosis of the femoral head to types of the vessel of medial artery circumfilex femora into femeral head:vessel of type 2 accounts for 22% before treating,type 2 accounts for 8% and type 4 and type 5 was increased after treating.④Relationship of treatment of osteonecrosis of the femoral head to diameter of the vessel of medial artery circumflex femora into femeral head:The diameter of medial artery circumflex femora is wider after treating,they are 0 89±0 21 and 0 60±0 14 seperately.Conclusions Occurrence and progress of osteonecrosis of femral head is related to medial artery circumflex femora into femeral head.The dredging operation for medial artery circumflex femora is worthy of being studied.