髓芯减压及保留置管灌注治疗股骨头坏死的临床应用.DOCVIP

临床医学论文-髓芯减压及保留置管灌注治疗股骨头坏死的临床应用 ?????????????? 作者：钟立清 陆笼辉 徐寅聪 【摘要】? 目的 通过开展有选择的经皮股骨头髓芯减压与股骨头供血血管即时及保留置管药物灌注微创介入治疗股骨头无菌性坏死（ANFH）28例，观察其临床疗效。方法 经皮股骨头髓芯减压术和采用seldinger技术：经对侧股动脉穿刺插管，股骨头供血血管即时及保留置管药物灌注介入治疗。结果 本组44髋介入治疗后，疼痛症状得到有效改善。关节功能除3例6髋晚期患者术后自述无明显改善外，其余患者术后均有不同程度改善。44髋中，X线复查阴性12髋，坏死骨吸收、骨质不同程度改善23髋，6髋与术前无明显变化，3髋坏死进一步加重。结论 采用双介入治疗并保留置管使局部供血动脉持续灌注综合治疗，本组病例显示具有一定疗效，尤其对于病程短、症状轻的1～2期疗效明显。 【关键词】? 髓芯减压； 介入治疗； 股骨头坏死 　　The Practice of Curing Necrosis of Femoral Head with Relaxing the Pressure through Marrow Core and Priming by Reserves Tube???? 　　【Abstract】? Objective? To observe the clinical performance of interventional therapy ANFH 28 cases，which are treated with skill relaxing the pressure by percutaneous skin femoral head marrow core and priming by reserves tube. Methods? Skill relaxing the pressure by percutaneous skin femoral head marrow core and seldinger technology refer as: interventional therapy of prime by reserves tube in treatment through the side femoral head puncture plunging tube, the femoral head bloodsupply blood and priming by reserves tube. Results? The pain sense of 28 cases was improved after interventional therapy except 3 cases who were nto changed of articular function.In the 44 coxae,12 were negative? in recheck of X rays,23 improved , 6 not obviously changed and 3 aggravated. Conclusion? The interventional therapy and priming by reserves tube are effective for ANFH, especially 1 to 2 phases of clinics.??? 　　【Key words】? Medullary core decompression； Interventional therapy； Necrosis of femoral head 　　股骨头无菌性坏死（avascular necrosis of femoral head，ANFH）是临床上较常见且缺乏有效治疗方法的一种疾病。近年来，通过开展经皮股骨头髓芯减压与股骨头供血血管即时及保留置管药物灌注微创介入治疗ANFH 28例患者计44例髋关节，经过临床观察，取得满意疗效。 　　1? 资料与方法 　　1.1? 一般资料? 本组病例男17例，女11例，年龄24～61岁，其中单髋患病12 例，双髋16例，计44髋。病程3个月～3年。病因：明确激素引起9例，长期酗酒12例，明确外伤史1例，先天性髋关节发育不良2例，不明原因4例。全部病例经摄X片及CT检查诊断，其中19例行MRI检查确诊。诊断早期表现15髋，中期23髋，晚期6髋。 　　1.2? 方法 　　1.2.1? 经皮股骨头髓芯减压引流? 在C型臂电视监视下，在患侧股骨粗隆下3 cm 左右行皮肤局麻，分离皮下组织至骨膜，用ZC1型骨钻沿股骨颈轴线分别钻3～4孔至头下0.5 cm 左右。取出骨质，剔除死骨再植入囊变区。 　　1.