牵引对犬股骨头血运影响的DSA研究

目的 探讨牵引对犬股骨头血循环的影响及其DSA评价.方法 采用经皮微导管旋股动脉DSA技术,对22只实验犬进行了2kg重力牵引前(A组,22只)、牵引中即刻(B组,22只)、30 min(D组,22只)、60 min(E组,20只)、90 min(F组,10只)、120 min(G组,10只)造影及牵引即刻去牵引即刻(H组,22只)、牵引30 min后去牵引即刻(I组,22只)、牵引60 min后去牵引即刻(J组,20只)、30 min(K组,20只)和牵引90 min后去牵引即刻(L组,10只)、30 min(M组,10只)、60 min(N组,10只)造影与牵引120 min后去牵引即刻(O组,10只)、30 min(P组,10只)、60 min(Q组,10只)造影;12只髋于持续牵引前同时作了4 kg重力牵引即刻造影(C组).主要观察股骨头灌注状态及循环时间,其评定标准:股骨头灌注状况分为好(3分)、差(2分)、极差(1分),循环时间6 s内为正常(3分)、>6 s为延长(2分)、>10 s为明显延长(1分),组间比较应用方差分析进行统计学处理.结果 A～Q组股骨头灌注好者分别为22、0、0、0、0、0、0、22、22、1、18、0、0、8、0、0、1髋,差者分别为0、22、8、22、15、4、1、0、0、15、2、4、6、2、1、3、8髋,极差者分别为0、0、4、0、5、6、9、0、0、4、0、6、4、0、9、7、1髋;其循环时间正常者分别为22、0、0、0、0、0、0、22、22、1、18、0、0、8、0、0、1髋,延长者分别为0、22、9、22、15、4、2、0、0、15、2、5、7、2、2、4、8髋,明显延长者分别为0、0、3、0、5、6、8、0、0、4、0、5、3、0、8、6、1髋.A组与B组、B组与C组及B、D、E、F、G组间、H、I、J、L、O组间、K、M、P组间、N组与Q组比较,股骨头灌注状态(F值分别为437.48、30.25、29.04、132.69、143.73、25.20,P值均为0.000)和循环时间(F值分别为386.26、31.83、22.43、141.94、119.69、21.68,P值均为0.000)差异均有统计学意义.结论 牵引引起了犬股骨头缺血反应与血运障碍,牵引时间越长、牵引力越大,股骨头灌注越差、循环时间越长、血运恢复越慢;DSA以血流动力学、血管构筑学指标直观地反映了这些改变.

Effects of traction on the blood circulation of femoral head: DSA study on a canine model

Objective To study the influence of traction on the blood circulation of femur head and its evaluation by DSA. Methods Using micro-catheter, transfemoral selective femoral circumflex arteriography in 22 healthy dogs was performed in unilateral hip before (Group A,n =22) and immediately (Group B,n=22) ,30( Group D,n =22) ,60(Group E,n=20) ,90( Group F,n = 10),120 (Group G,n=10) minutes during 2 kg skin hip traction, and immediately after traction removal (Group H,I,J,L and 0), and 30 minutes after traction removal with 60,90 and 120 minutes continuous traction(Group K,M and P),and 60 minutes after traction removal with 90 and 120 minutes continuous traction(Group N and Q). DSA was also performed immediately during 4 kg weight traction before continuous traction in 12 hips( Group C).Blood circulation of the femoral head was evaluated mainly by observing its perfusion and time of circulation. Femur head perfusion was assessed as good scoring 3,poor scoring 2 and extremely poor scoring 1. Femur head circulation time was assessed as normal scoring 3 .prolonged scoring 2 and remarkably prolonged scoring 1. Analysis of variance was employed for analysis of the angiographic findings between different groups.Results Good femoral head perfusion in Group A to Q was 22,0,0,0,0,0,0,22,22,1,18,0,0,8,0,0 and 1 hips respectively, poor one was 0,22,8,22,15,4,1,0,0,15,2,4,6,2,1,3 and 8 hips, respectively,extremely poor one was 0,0,4,0,5,6,9,0,0,4,0,6,4,0,9,7 and 1 hips, respectively; and normal femoral head blood circulation time was 22,0,0,0,0,0,0,22,22,1,18,0,0,8,0,0 and 1 hips, respectively, prolonged one was 0,22,9,22,15,4,2,0,0, 15,2,5,7,2,2,4 and 8 hips, respectively, remarkably prolonged one was 0,0,3,0,5,6,8,0,0,4,0,5,3,0,8,6 and 1 hips, respectively. F value of femoral head perfusion among group A and B,group B and C,group B,D,E,F and G,Group H,I,J,L and O,group K,M and P,Group N and Q was 437. 48,30. 25,29. 04,132. 69,143. 73,25.20, respectively, and their P value was all <0. 01. F value of femoral head circulation time among group A and B,group B and C,group B,D,E,F and G,Group H,I,J,L and O,group K,M and P,Group N and Q was 386. 26,31. 83,22.43,141. 94,119.69,21.68, respectively, and their P value was all < 0.01. Conclusions Traction could lead to ischemic response and circulation disorder of canine femoral head. The longer the traction time or the bigger the traction weight was, the poorer the femoral head perfusion and the longer the femoral head circulation time were, and the slower they recovered. DSA could directly reflect these changes in the femoral head with these angioarchitectural and hemodynamic indexes.