股骨颈骨折后选择性血管造影评价股骨头血液循环

目的 探讨选择性血管造影检查对评价股骨颈骨折后早期股骨头血液循环损伤及影响因素的价值。方法采用选择性旋股动脉及支持带动脉造影(DSA)，对9例2～23天内单侧股骨颈骨折患者血管损伤和血液循环改变进行评价。结果髋关节囊内出血2例，骨内出血4例，下、后支持带动脉损伤和血管移位各3例。患髋牵引时，除外下支持带动脉，其他支持带动脉无显影或仅显示起始部主干，相应股骨头颈部几无灌注成像，静脉显影延迟；髋关节维持伸直内旋位或囊内注入生理盐水后造影，所有支持带动脉无明确显影或仅显示其主干，股骨头颈部无灌注、染色，静脉显影延迟。结论选择性旋股内、外侧动脉DSA技术是一项准确评价股骨颈骨折后股骨头血液循环损伤及影响因素的微创性检查方法；股骨头血液循环受髋关节体位、囊内压和牵引等因素影响；牵引可导致或加重股骨颈骨折后股骨头缺血。

Selective digital subtraction angiography in assessment of blood circulation in acute femoral neck fracture

Objective To observe the influence of femoral neck fracture and other factors on blood circulation of femoral head by selective digital subtraction angiography (DSA). Methods Nine patients with single femoral neck fracture underwent DSA of selective deep femoral artery and femoral circumflex artery from 2 to 23 days after fracture in the absence of traction and in the presence of 3 kg and 5 kg hip traction in the neutral position and the internal rotating position without flexing the legs. Partial retinacular artery angiography was done simultaneously using a micro-catheter in 3 patients. And in 4 patients, angiography was performed before intra-osseous venography and immediately after saline injection into the articular capsule respectively. Results Intra-articular hemorrhage was observed in 2 patients and intra-osseous hemorrhage in 4 patients. One of the inferior and posterior reticular arteries from the medial femoral circumflex artery was injured in 3 cases. Both medial and lateral circumflex arteries were displayed clearly when the image amplifier rotated 25-30° internally. On 80% of DSA images, both vessels and bones were displayed well. Blood perfusion and vein drainage of the femoral head were imaged similarly in both arterial DSA and intra-osseous venography. Intramedullary angiography failed in one patient because of unbearable pain. Few branches and little femoral head blood perfusion was observed in all of retinacular arteries with exception of inferior reticular arteries when the hip traction was performed in the neutral position with angiography using the same contrast injection rate and volume, where veins demonstration and blood circulation of the femoral head were delayed. This change was more notable as traction heavy increased from 3 kg to 5 kg. And so it was with all retinacular arteries while hip joint was internally rotating with straight leg and after saline injection into articular capsule. Conclusion Selective femoral circumflex artery DSA is a microinvasive technique for accurate assessment of femoral head blood circulation and its influent factors after femoral neck fracture. Posture of the hip, intra-articular pressure and traction are factors affecting blood circulation of the femoral head,and hip traction may cause or aggravate avascular necrosis of the femoral head.