成人非创伤性股骨头坏死DSA表现及介入治疗疗效观察

Interventional Therapy Effect and DSA Image of the Nontrauma Avascular Necrosis of the Femoral Head

目的 探讨成人非创伤性股骨头缺血性坏死 (ANFH)的数字减影血管造影 (DSA)表现及介入治疗的效果。方法 对 3 6例 5 2髋ANFH患者 ,采用Seldinger技术经皮股动脉穿刺插管 ,行高选择性股骨头供血动脉的DSA检查及药物灌注。结果 3 6例的 5 2髋中 5 0髋 (96.2 % )有供血动脉的异常改变 ,40髋 (76.9% )股骨头有不同程度和范围的染色 ,2 5髋(4 8.1% )显示股骨头静脉引流异常。治疗后髋关节疼痛症状消失或好转 ,关节功能明显得以改善。DSA复查 ,髋关节周围交通吻合的显示明显增多 ,5 3 .8% (2 8/ 5 2 )的患髋股骨头显示单位面积上血管数量增加。经治疗 1年后X线平片及CT复查 ,71.2 % (3 7/ 5 2 )患髋股骨头显示不同程度的骨质修复。结论 介入治疗ANFH疗效肯定 ,对改善局部血液循环 ,缓解临床症状、恢复髋关节功能及促进股骨头的新骨形成及修复起到了重要作用。但在选择靶动脉药物灌注时应结合术前造影所见 ,特别应重视对臀下动脉的选择。

Objective To explore the digital subtraction angiograpthy(DSA) characters and the effect of interventional therapy on avascular necrosis of the femoral head. Methods Fifty two pieces in 36 patients with the avascular necrosis of the femoral head were examined and treated with DSA or perfusion of drug. Results Fifty pieces (96.2%) were abnormal in the femoral head's artery, 40 pieces (76.9%) were abnormal in the image of the femoral head and 25 pieces (48.1%) were abnormal in the vein of the femoral head. After treatment, in the patients, the pain of the hip was alleviated, the blood vessel anastomosis and the dense of the blood vessel in the femoral head increased. After one year, 37(71.2%) of 52 pieces, the osseous repair were indicated by means of X ray photogram or CT. Conclusion The effect of interventoinal therapy on the avascular necrosis of the femoral head is good, and it can improve the local blood circulation and the function of the hip.