药物灌注治疗股骨头缺血坏死的效果及MRI表现

Effects and MRI findings of drug perfusion in treatment of avascular necrosis of femoral head

目的 探讨股骨头缺血坏死(ANFH)的介入性药物灌注治疗效果及磁共振(MRI)表现。方法 回顾性分析于我院行介入性药物灌注治疗的48例(58髋)ANFH患者的临床资料,分别在治疗前行视觉模拟法(VAS)、Harris-髋关节功能评估及MRI检查,依据MRI检查结果进行国际骨循环学会(ARCO)股骨头缺血坏死的分期、骨髓水肿分级、关节腔积液评估。患者治疗结束后再行24个月院外随访,并于患者治疗后6、12、24个月进行VAS、Harris评估及MRI检查。对比ANFH患者治疗前及治疗后不同时点VAS、Harris评分和ARCO分期、骨髓水肿分级、关节腔积液分级差异。结果 ANFH患者Harris评分对比治疗前<治疗后6个月<治疗后12个月、治疗后24个月,而VAS评分对比治疗前>治疗后6个月>治疗后12个月、治疗后24个月,差异有统计学意义(P<0.05)。ANFH患者治疗期间ARCO分期对比差异无统计学意义(P>0.05)。ANFH患者治疗后24个月骨髓水肿分级Ⅰ级患者占比显著高于治疗前,差异有统计学意义(P<0.05)。ANFH患者治疗期间关节腔积液分级对比差异无统计学意义(P>0.05)。结论 介入性药物灌注治疗ANFH能明显缓解患者疼痛症状,提高髋关节功能,同时通过MRI可以动态观察介入性治疗后不同阶段的骨髓水肿情况。

Objective To investigate the effect of interventional drug perfusion therapy and magnetic resonance imaging(MRI) of femoral head ischemic necrosis(ANFH).Methods The clinical data of 48 patients(58 hips) with ANFH who received interventional drug infusion therapy in our hospital were retrospectively analyzed. Visual analogue scale(VAS),Harris-hip function assessment and MRI examination were performed before treatment. According to the results of MRI examination,the stages of ischemic necrosis of the femoral head,grade of bone marrow edema and joint cavity effusion were evaluated by the International Society of Bone Circulation(ARCO).Patients were followed up 24 months after treatment,and VAS,Harris assessment and MRI were performed 6,12 and 24 months after treatment. VAS,Harris score,ARCO stage,grade of bone marrow edema and grade of joint cavity effusion were compared between ANFH patients at different time points before and after treatment.Results Harris score of ANFH patients was compared with that before treatment < 6 months after treatment < 12 months after treatment and 24 months after treatment,and VAS score was compared with that before treatment > 6 months after treatment > 12 months after treatment and 24 months after treatment,with statistical significance(P<0.05).There was no significant difference in ARCO stage of ANFH patients during treatment(P>0.05).The proportion of ANFH patients with grade ⅰ bone marrow edema 24 months after treatment was significantly higher than that before treatment,with statistical significance(P<0.05).There was no significant difference in the grade of ANFH patients’ articular effusion during treatment(P>0.05).Conclusion Interventional drug infusion treatment of ANFH can significantly relieve patients’ pain symptoms and improve hip joint function. Meanwhile,MRI can dynamically observe the bone marrow edema at different stages after interventional therapy.