成人股骨头缺血性坏死合并骨髓水肿的介入治疗

The intervention therapy of adult avascular necrosis of femoral head combined with bone marrow edema

目的探讨成人股骨头缺血性坏死合并骨髓水肿的介入治疗及其疗效观察。方法选择临床症状突出,经磁共振成像(MRI)检查证实的成人股骨头缺血性坏死合并骨髓水肿的患者20例,24髋,经对侧股动脉插管,分别超选择至患侧旋股内、外动脉,闭孔动脉开口,造影确定导管位置后,灌注溶栓剂、解痉剂及血管扩张剂等。结果①经2次或3次介入灌注术后与灌注前造影片对比,股骨头颈部血管增多、增粗、股骨头染色变深16例22髋,2例2髋改变不明显。②本组20例中有19例患者疼痛消失、明显减轻或缓解,总有效率占95%。③24个髋关节介入治疗前后活动范围均有不同程度改善。④16髋介入治疗后MRI对比,骨髓水肿明显减轻。结论介入灌注术治疗股骨头缺血性坏死合并骨髓水肿疗效确切。

Objective To explore adult avascular necrosis of femoral head combined with bone marrow edema, and to assess the curative effect of interventional therapy. Methods Twenty patients with avascular necrosis of femoral head combined with bone marrow edema were selected with obvious clinical symptoms, confirmed by MRI. Twenty four of the hips were treated with the contralateral femoral artery intubation. Lateral femoral circumflex artery medial femoral circumflex artery and obturatoria artery were cannulated respectively. After successful catheterization and accurate loeating,thromlytic drugs,spasmolysis agent and vasodilator were infused sequentially. Results ①Two sessions or 3 sessions of interventional perfusion thereafter, preproeedural and postprocedural angiograms were com- pared and followed up. Increased and enlarged femoral head and neck vascularity was observed, and femoral head stain became darker in 16 cases, 2 cases were not obvious. ②Hip pain disappeared, or significantly reduced or alle viated in 19 of 20 patients in this group, the total effective rate was 95%. ③The articulation motin range was improved to different degrees in 24 hips. 4（4（4~Postprocedura! hip MRI denoted bone marrow edema of 16 hips alleviated obviously. Conclusion To treat avascular necrosis of femoral head combined with bone marrow edema by interven tional perfusion has definite therapeutive effect.