综合介入法治疗股骨头缺血性坏死的应用研究（附130例报告）

目的评价综合介入法连续性治疗股骨头缺血性坏死（ANFH）的临床疗效。方法经X线平片、CT和MRI检查及临床证实的ANFH130例，首先进行经动脉介入治疗，3d后行股骨头经皮髓芯减压术，同时行经皮介入外置管治疗，保留外引流管一周。疗效评定指标：治疗前后动脉数目和静脉回流的变化；临床症状的改变；X线平片、MRI定期随访。结果所有患者于治疗后1a复查X线平片显示45例骨质完全修复，85例有不同程度的骨质修复；DSA显示107例动脉数目明显增多，10例动脉数目略多，13例无变化；静脉回流时间变化，128例静脉回流加快，2例静脉回流无变化；MRI显示118例骨髓水肿消退，12例残留散在小斑点状骨髓水肿信号病灶；临床症状，67例治疗后疼痛完全消除，大部分缓解34例，部分缓解29例，其临床症状改善率100％。结论综合介入法治疗ANFH，能明显改善股骨头的血液循环，促进股骨头坏死区的修复和重建，是一种安全、有效的疗法。

Application study of overall Intervention therapy for treating avascular necrosis of the femoral head.repot of 130 cases

Objective To evaluate the clinical efficacy of overall intervention therapy for treating avascular necrosis of the femoral head （ANFH）.Methods A hundred and thirty patients with ANFH confirmed by plain radiography,CT,MRI and clinical manifestation initially underwent intraarterial intervention therapy,interval-three days,additionally underwent percutaneous core decompression,simuhaneously,external drainage catheters were inserted into necrotic areas of the femoral head and reserved for a week.The evaluation indices of the therapeutic efficacy included the changes of arterial number,venous return volume and clinical symptom before and after the intervention therapy.All patients were periodically followed up by using plain radiography,DSA and MRI.Results The reexaminations of all patients were performed at one year after the treatment.Plain radiography showed osteonecrosis of the femoral head to be complete repair in 45 cases and incomplete repair in 85 cases.DSA showed arterial number to be obvious inerease in 107 cases,slight increase in 10 cases, non-increase only in 13 cases;venous return to be accelerated in 128 cases,non-changed only in 2 cases.MRI showed disappearance of marrow edema signals in 118 cases,scattered residue of small mottling marrow edema signals only in 12 cases.The main symptoms and signs in 67 patients were controlled effectively,those in 34 patients were improved markedly,and those in 29 patients were relieved partially,so that the effective rate was 100% .Conclusion Overall intervention therapy can significantly improve the blood supply of the femoral head and accelerate the repair and reconstruction of ANFH and therefore it is a safe and effective means for treating ANFH.