介入治疗在股骨头缺血坏死中应用.docVIP

介入治疗在股骨头缺血坏死中应用 　【摘要】 目的：评价介入治疗股骨头缺血坏死的疗效，探索股骨头缺血坏死的治疗方法。方法：对28例股骨头缺血坏死患者采用介入插管的方法，超选择进入到股骨头营养血管旋股内、外侧动脉和闭孔动脉，造影观察其血液供应情况后，注入溶栓药物、扩血管药物及改善微循环药物，术后再次造影观察对比股骨头供血改变情况，并于12个月~36个月摄X光片与术前相片对比观察股骨头骨质改变情况。结果：治疗前后血管造影对照显示治疗后血管增多，股骨头染色增强，12个月~36个月后平片显示骨密度增高者占97.2%，临床症状明显改善。结论：通过介入方法治疗股骨头缺血坏死是一种安全有效的治疗方法，能在临床上广泛应用。 【关键词】 股骨头缺血坏死；介入治疗；发病机制 　　The Application of Interventional Therapy to ANFH Abstract： Objective To evaluate the curative effect of ANFH treated by interventional therapy,and search after remedial method. Methods Twentyeight patients suffering ANFH were treated by catheterization. In invention therapy ,throm olytic agents,vasodilator drugs,and drugs improving microirculation were injected directly into the arteries supplying the femoral head, after superselected .And contrast the changing of the arteries supplying the femoral head between preoperative and postoperative,and the density of the femoral head between the operation and 12~36 month after operation. Results The angiography show the arteries supplying the femoral head were manifold, the coloration of the femoral head were enhanced after interventional therapy.The Xray photograph show the density of the femoral head were heighten by 97.2%.And the clinic symptom were improved. Conclusion Interventional therapy is a safe and effective remedial method to ANFH,which seems to be promising for wide clinical application. Key words: Avascular necrosis of femoral head (ANFH); Interventional therapy 随着现代介入医学的发展，介入治疗在股骨头缺血坏死的治疗中占有越来越重要的地位。我们自1998年7月以来，开展了股骨头缺血坏死的介入治疗，手术方法为经皮股动脉穿刺进行旋股内、外动脉及闭孔动脉药物灌注治疗。临床上取得了较满意的效果。现将结果总结如下。 　　1 资料与方法 　　1.1 一般资料 　　本组共28例，其中男性19例，女性9例；年龄14岁~70岁，平均年龄38岁，双侧8例，单侧20例（其中左侧13例，右侧7例）；病程5个月~32个月，均经X线平片、CT及MRI确诊。临床表现主要为患髋疼痛、患肢活动受限，有５例患者伴跛行。临床病史主要为股骨颈骨折、饮酒及服用激素等；其中股骨颈骨折7例，有饮酒史者３例，服用激素者13例,其他原因引起者5例。有15例患者19个股骨头行单次治疗，13例患者17个股骨头行2次治疗。 　　1.2 治疗方法 　　采用Seldinger技术，将5F Cobra导管分别送至股动脉和患侧髂内动脉，用300优维显10 ml~15 ml，以3 ml/s~5 ml/s流速，10帧/s数字减影血管造影10 s，然后超选择至旋股内动脉、旋股外动脉、闭孔动脉，造影观察股骨头的供血情况（见图1、图2），后分别注入复方丹参注射