经导管灌注治疗股骨头缺血性坏死的临床和影像学随访研究

Transcatheter arteries perfusion therapy for avascular necrosis of the femoral head : clinical and imagical follow-up study

目的评价经导管灌注治疗ANFH的临床疗效。方法对182例经临床和影像学检查确诊的ANFH患者采用经导管股骨头供血动脉药物灌注治疗并比较治疗前后临床症状、髋关节功能及影像学改变。随访观察1年～6年,平均4年2个月。按Ficat分期,0期4髋;I期44髋;II期116髋;III期35髋,IV期17髋。结果经导管动脉灌注治疗后,患者疼痛、生活能力、关节活动度及行走距离较前明显改善(P<0.01);X线平片显示治疗后3个月无变化,6个月可见部分修复,1年可见明显修复,同时坏死加重亦明显,以后随时间延长病变趋于稳定;MRI随访58髋,发现32髋(55.2%)有不同程度的好转,19髋(32.8%)病变基本保持不变,7髋(12.1%)病变加重。血管造影或DSA评价191髋,77髋(40.3%)有好转表现,112髋(58.6%)未见明显血管改变,2髋加重。评价指标以血管形态学改变为主。结论经导管动脉灌注治疗ANFH对促进坏死骨吸收和新骨形成修复起到积极的作用,能终止逆转部分ANFH坏死病理进程。结果表明该方法有较好的远期疗效。

Objective To evaluate the long-term clinical effect of the ANFH treated by transcatheter arteries perfusion therapy. Method According to the modified Ficat system, 216 hips in one hundred eighty two ANFH patients are researched within 1 to 6 years follow-up. There are 4 hip at stage 0;44 at stage I;116 at stage II;35 at stage III;17 at stage IV. Comparing the clinical symptoms、hip function and the changes of medical image. Result Within 1 to 6 years after transcatheter arteries perfusion therapy ,pain , viability , activity and walking distance of the patients with ANFH were significantly improved than those before the therapy(P< 0.01); Plain radiographys shows some bone tissues were repaired in various degrees after therapy. MRI shows the decreasing signals of bone marrow oedema and effusion of joints, the decreasing scope of bone necroses and necrotic bones. The lesions of 32 in 58 hips(55.2%) were improved after therapy; 19 in 58 hips(32.8%) were not changed; but 7 hips(12.1%) were further progressed. DSA or superselective angiography indicates the disorders of 77 in 191 hips(40.3%) were improved after the procedure; 112 hips(58.6%) were not changed; 2 hips were further progressed. Conclusion Transcatheter arteries perfusion therapy would have a good long-term therapy effect on the patients with ANFH.This procedure may have effective in promoting the repair of bone and disease progression.