股骨头坏死保髋术后血管再生的临床研究

Clinical study on angiogenesis after hip preserving surgery for osteonecrosis of the femoral head

目的:应用超声造影(CEUS)评估早期股骨头坏死(ONFH)保髋手术后修复阶段股骨头新生血管的再生情况。方法:收集因ONFH行保髋手术的患者21例(24髋,术后组)及健康成人17例(17髋,正常组),对以上受检者进行二维超声及CEUS检查,并建立时间-强度曲线(TIC)进行定量分析,获得的血流灌注参数包括平均渡越时间(mTT)、造影峰值强度(PI)、曲线上升斜率(AS)、曲线下降斜率(DS)及时间-强度曲线下面积(TIC-AUC),并比较以上参数在术后组与正常组中的差异。结果:保髋手术后修复阶段股骨头造影剂微泡灌注较正常组丰富。术后组mTT(64.97±13.96)和DS(-0.24±0.07)显著低于正常组(mTT:79.78±13.2,DS:-0.12±0.04),PI(33.74±3.94)、AS(2.39±0.60)和TIC-AUC(2638.42±340.36)显著高于正常组(PI:25.50±4.92,AS:1.28±0.65,TIC-AUC:2162.97±353.40),差异均有统计学意义(P值均<0.05)。结论:CEUS可以定量检测股骨头坏死保髋术后股骨头修复血管再生情况,为临床保髋术后疗效评定提供参考依据。

Objective:To evaluate the regeneration of femoral head neovascularization during the repair phase after hip preserving surgery for early stage of osteonecrosis of the femoral head(ONFH)using contrast-enhanced ultrasound(CEUS).Methods:Twenty-one patients(24 hips,postoperative group)with ONFH who were treated with hip preserving surgery and 17 healthy adults(17 hips,normal group)were enrolled.Two dimensional ultrasound and CEUS were performed on all the subjects and time intensity curve(TIC)was established for quantitative analysis.The parameters of blood perfusion were obtained,including mean Transit Time(mTT),Peak Intensity(PI),Ascending Slope(AS),Descending Slope(DS)and Area Under Curve of time intensity curve(TIC-AUC).The differences of the parameters were compared between the postoperative group and normal group.Results:More abundant microbubble perfusion of contrast agents was observed in femoral head during the repair stage after hip preserving surgery than in the normal group.The mTT(64.97±13.96)and DS(-0.24±0.07)in the postoperative group were significantly lower than those in the normal group(mTT:79.78±13.2,DS:-0.12±0.04),while the PI(33.74±3.94),AS(2.39±0.60)and TIC-AUC(2638.42±340.36)were significantly higher than those in the normal group(PI:25.50±4.92,AS:1.28±0.65,TIC-AUC:2162.97±353.40).All the differences were statistically significant(all P<0.05).Conclusion:CEUS can quantitatively detect the angiogenesis of femoral head after hip preserving surgery for ONFH,and provide a reference for clinical evaluation of the curative effect after hip preserving surgery.