DSA技术对下肢血管损伤患者股骨头颈血供的研究

采用数字减影血管造影（DSA）技术，观察11例（18髋）下肢血管损伤患者的旋股内动脉、旋股外动脉、闭孔动脉及臀下动脉起点、分布及走行。结果显示，旋股外动脉主要起于股深动脉；旋股内动脉起始点不恒定；闭孔动脉多起于髂内动脉干前支，并与旋股内动脉形成吻合；臀下动脉发自髂内动脉干前支，75％与旋股内动脉分支、60％与旋股外动脉分支形成吻合。认为旋股内、外动脉是介入治疗股骨头坏死的主要靶血管，闭孔动脉、臀下动脉常作为补偿靶血管；DSA技术有助于判断股骨头颈血管的分布特征。     

髓芯减压加钽棒植入治疗老年非创伤性股骨头坏死疗效及塌陷预测安全性

目的探讨髓芯减压加钽棒对老年非创伤性股骨头坏死的治疗效果。方法将2010年7月至2014年9月因非创伤性股骨头坏死进入该院治疗的老年患者80例,将其随机均衡分为研究组和对照组各40例,研究组采用髓芯减压加钽棒植入进行治疗,对照组采用传统髓芯减压作为治疗方式。在疗程结束后,对所有患者主要临床指标、髓关节功能状况、塌陷状况进行安全性预测对比分析。结果研究组手术时间、术中失血量、术后恢复时间以及住院时间等指标均优于对照组(P0.05);研究组优24例,良16例,优良率高达100.00%,对照组患者优13例,良15例,可12例,优良率为70.00%,两组比较差异显著(P0.05);研究组仅出现1例塌陷,对照组出现12例,两组比较差异显著(P0.05)。结论采用髓芯减压加钽棒植入治疗老年非创伤性股骨头坏死患者,疗效确切,手术创伤较小、出血量较少、手术时间较短,术后并发症少,恢复状况较好,可推广应用。     

酒精性股骨头缺血性坏死的研究现状和进展

近年来酒精性股骨头缺血性坏死的发病率呈逐年上升的趋势,由于目前动物模型的局限性,使得其病因和发病机理的研究仍无法达到临床的要求,在临床治疗方面也尚无突破性进展。该文就国内外酒精性股骨头缺血性坏死研究的现状和进展予以综述。     

数字减影血管造影对原发性肝癌的术前评价

目的评价数字减影血管造影（DSA）对我国原发性肝癌术前的意义。方法回顾分析1998年5月～2007年5月1000例原发性肝癌术前的DSA影像与多层螺旋CT（MSCT）及彩超检查结果。结果三种方法发现肝癌1000例,直径3em以上的700例肝癌中,DSA发现670例;240例小肝癌中DSA发现202例;30例弥漫性肝癌中,DSA发现28例;900个子灶中,DSA发现890个;440例门脉癌栓中,DSA发现362例;490例动静脉瘘、动门脉瘘中,DSA发现482例。结论DSA检查对原发性肝癌的术前评价具有不可替代的作用。     

胰岛素瘤的数字减影血管造影诊断

胰岛素瘤是胰岛的Ｂ细胞肿瘤 ,瘤体直径仅 10～ 2 0ｍｍ ,定位诊断比较困难。本文分析经手术病理证实的 2 2例胰岛素瘤的数字减影血管造影 (ＤＳＡ)等影像学资料 ,以探讨其在胰岛素瘤诊断中的价值。一、资料和方法2 2例中男 9例 ,女 13例。年龄 19～ 81岁 ,平均 49岁。病程 2个月～ 8年。所有患者均有典型的Ｗｈｉｐｐｌｅ三联征 ,其中 10例在低血糖发作时伴有抽搐、精神错乱、言语不清和运动失调等神经精神症状。实验室检查 2 2例空腹和发作时血糖均明显低于正常 ,血清胰岛素水平升高。2 2例术前均作Ｂ超和ＤＳＡ检查。ＤＳＡ采用Ｓｅｌｄ…     

经股骨颈开槽死骨刮除、按压力骨小梁方向植骨治疗股骨头坏死35例疗效观察

目的观察经股骨颈开槽死骨刮除并按压力骨小梁方向植骨治疗股骨头坏死（ONFH）的疗效。方法将68例（75髋）ONFH患者随机分为观察组35例（38髋）和对照组33例（37髋）,两组均行经股骨颈开槽死骨刮除,观察组按照压力骨小梁方向进行植入支撑骨块,对照组按照颈干角方向植入支撑骨块。术后随访19～28个月（平均24个月）,观察两组临床疗效和髋关节功能。结果观察组治疗未塌陷率为84.2%,对照组为62.2%,P〈0.01;观察组Harris评分优良率为89.5%,对照组为62.2%,P〈0.01。结论经股骨颈开槽死骨刮除并按压力骨小梁方向植骨治疗ONFH能增强股骨头内的支撑强度,稳定股骨头的应力环境,有利于坏死修复,可有效预防ONFH塌陷。     

股骨头缺血性坏死基因治疗的研究进展

股骨头缺血性坏死(avascular necrosis of femoral head,ANFH)是因股骨头微循环障碍等一系列病理生理变化而最终导致股骨头坏死的疾病。微循环障碍是ANFH的最常见病因,改善股骨头微循环可促进ANFH修复与再生,血管内皮生长因子(vascular endothelial growth factor,VEGF)基因转染骨髓间充质干细胞在治疗ANFH时有显著效果,Foxc2基因转染骨髓间充质干细胞在植入坏死的股骨头后可促使间充质干细胞及成骨前体细胞向成骨细胞分化,从而修复股骨头坏死,骨桥蛋白基因高表达可促进成骨细胞的增殖分化,p53基因高表达造成骨细胞生成减少,凋亡增加,而bcl-2增高可抑制细胞凋亡。该文就ANFH的基因治疗研究进展进行综述。     

CT血管造影在脑血管病诊断中的应用

数字减影血管造影一直被公认为是脑血管检查的金标准.随着CT技术的发展,CT血管造影(CTA)已广泛应用于颅内外血管的检查.文章就CTA技术的发展及其在脑血管病诊断中的应用做了综述.     

容积CT数字减影血管造影和三维数字减影血管造影诊断颅内动脉瘤的价值比较

目的对比容积CT数字减影血管造影(VCTDSA)和三维数字减影血管造影(3D-DSA)在颅内动脉瘤诊断中的价值。方法疑似颅内动脉瘤患者74例,男31例,女43例,平均72.3岁。均行VCTDSA和3D-DSA检查,两位评价者分析此两项检查的影像资料,记录动脉瘤检出的个数、部位及大小,并评价VCTDSA的诊断效能(包括敏感性、特异性、阳性预测值和阴性预测值)及两种技术诊断动脉瘤的一致性。结果 3D-DSA检出动脉瘤94个,VCTDSA检出93个(评价者A检出93个,评价者B 92个);评价者A检出全部动脉瘤以及检出3 mm动脉瘤的敏感性和阴性预测值较评价者B高,而两者检出≥3 mm动脉瘤的敏感性和特异性均为100%;在检出动脉瘤个数、部位和大小三方面,3D-DSA和VCTDSA有很好的评价者间的一致性。结论 VCTDSA的动脉瘤检出效能与3D-DSA相当,可以作为颅内动脉瘤影像诊断的准确方法。     

多孔髓芯减压联合髋关节镜清理术治疗早期股骨头缺血坏死

目的 观察多孔髓芯减压联合髋关节镜清理术治疗早期股骨头缺血坏死(ANFH)的疗效.方法 将60例早期ANFH患者随机分为观察组23例(30髋)和对照组25例(30髋),分别行多孔髓芯减压联合髋关节镜清理术及传统股骨头髓芯减压术,术后采用髋关节Harris评分及影像学检查评定治疗效果.结果 患者均获随访5个月～3 a(平均32.3个月),术中、术后无严重并发症发生;观察组和对照组临床成功率分别为86.7%、60.0%(P<0.05),影像学成功率为83.3%、70.0%(P<0.05).结论 多孔髓芯减压联合髋关节镜清理术治疗早期ANFH短期疗效肯定,长期疗效有待于进一步观察.     

Distribution of hip pain in patients with idiopathic osteonecrosis of the femoral head

Objective: To determine the distribution of referred hip pain in patients with idiopathic osteonecrosis of the femoral head (ION).

Methods: We prospectively documented 119 hips in 90 patients with ION (mean age 51 years). Patients identified the location of pain originating in their hip on a drawing of the body. Osteoarthritis of the hip (OA) was used as a historical cohort.

Results: Referral of pain originating from the hip in patients with ION was 93% (111 hips) to the groin, 68% (81 hips) to the knee, 36% (43 hips) to the anterior thigh, 34% (40 hips) to the buttock, 18% (22 hips) to the lower leg, 9% (11 hips) to the greater trochanter, and 8% (9 hips) to the low back. About 97% (115 hips) of pain was located in the hip region (groin, buttock, and greater trochanter) and 77% (92 hips) showed referred pain (anterior thigh, knee, lower leg, and low back). Pain from ION was significantly more frequent in the knee and lower leg, but significantly less frequent in the lower back than pain from OA.

Conclusion: We should be aware of ION masquerading as pain in the knee or anterior thigh.     

Chronic myeloid leukaemia presenting as femoral head necrosis

A 17-year-old male whose initial presentation of chronic myeloid leukaemia (CML) was necrosis of the right femoral head is reported. This is the first case report to our knowledge of CML presenting with such a lesion and is of further interest in that almost all reported cases of destructive bony lesions in this disease have been associated with blast transformation. Our patient in contrast has remained in stable chronic phase for over 30 months.     

Diffusion tensor imaging of the sciatic and femoral nerves in unilateral osteoarthritis of the hip and osteonecrosis of femoral head: Comparison of the affected and normal sides

Abstract

Objective: The aim was to compare the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the sciatic and femoral nerves in patients with unilateral osteoarthritis of the hip (OA) and osteonecrosis of the femoral head (ONFH) using diffusion tensor imaging (DTI) and to investigate the mechanism of hip pain.

Methods: Forty-four patients (22 OA and 22 ONFH) underwent DTI of the sciatic and femoral nerves at the level of the hip joint and the S1 roots to visualize the tractography and quantify the FA and ADC values.

Results: The tractography of the femoral and the sciatic nerves on the affected side with OA and ONFH were similar to those on the normal side. The mean FA values of the sciatic and femoral nerves, and the S1 roots were 0.542, 0.551, and 0.316 with OA, 0.568, 0.560, and 0.318 with ONFH on the affected side, and 0.559, 0.560, and 0.315 on the normal side, respectively, and did not show significant differences. The FA values of the sciatic nerve on the affected side with OA decreased with longer pain duration.

Conclusion: The FA and ADC values of the sciatic and femoral nerves in patients with unilateral OA and ONFH showed no significant differences between the affected and normal sides.     

Identification of an IGF1 mutation (c.15+3G>A) in familial osteonecrosis of the femoral head: A case report

Rationale:Osteonecrosis of the femoral head is a common orthopedic disease. Some studies have shown that osteonecrosis of the femoral head is related to susceptibility genes, but there are few reports of familial osteonecrosis of the femoral head. Here, we reported two first-degree relatives with osteonecrosis of the femoral head.Patient concerns:A 27-year-old man with bilateral hip pain was diagnosed with osteonecrosis of the femoral head. The patient''s mother also had a history of this disease.Diagnoses:Whole exome sequencing revealed the same mutation (c.15+3G>A) in the insulin-like growth factor 1 (IGF1) gene of the proband and his mother but not in his elder sister.Interventions:The patient underwent bilateral total hip arthroplast.Outcomes:The patient recovered well, and was discharged.Lessons:We found a heterozygous mutation (c.15+3G>A) in IGF1 in this family, which could be related to osteonecrosis of the femoral head. Early genetic counseling and gene locus detection could, thus, prove helpful for early diagnosis of osteonecrosis of the femoral head.     

Effectiveness and safety of traditional Chinese medicine in the treatment of steroid-osteonecrosis of femoral head: A protocol for systematic review and meta-analysis

Background:Osteonecrosis of the femoral head (ONFH) is a common refractory disease in orthopedics. Overdose glucocorticoid application is a common trigger for ONFH. Traditional Chinese medicine (TCM), as a treatment for ONFH, has been shown to be effective in treating steroid-induced ONFH (SONFH). However, a systematic review and meta-analysis of them is lacking. We aim to systematically review the effectiveness and safety of TCM in the treatment of SONFH.Methods:We will search the following databases: PubMed, Embase, the Cochrane Library, MEDLINE, the Chinese Biomedical Literature Database, China Science and Technology Journal Database, China National Knowledge Infrastructure, and Wanfang Data (since the inception of the databases to the present). In addition, we will look for clinical trial registrations, prospective grey literature, relevant conference papers, and established study reference lists. We will use Review Manager 5.3 software for meta-analysis and heterogeneity assessment. We will evaluate the quality of the evidence using a hierarchy of recommendation assessment, development, and evaluation.Results:This study will systematically evaluate the efficacy and safety of TCM in the treatment of SONFH.Conclusion:This systematic review to evaluate the effectiveness and safety of TCM in the treatment of SONFH will provide updated evidence for clinical application.INPLASY registration number:INPLASY202170015.     

rhBMP-2/卵磷脂复合物治疗股骨头坏死的实验研究

目的观察人重组骨形态发生蛋白-2（rhBMP-2）／卵磷脂复合材料修复早期兔股骨头坏死（ANFH）病灶清除后缺损区的成骨能力,为临床治疗股骨头坏死提供新方法。方法采用液氮冷冻制备兔双侧股骨头坏死动物模型,实验侧植入rhBMP-2／卵磷脂复合材料,对照侧植入单纯卵磷脂片;3、6、9周时取股骨头标本进行组织学检查及碱性磷酸酶（ALP）活性、Ca^2＋测定,评价rhBMP-2／卵磷脂复合材料成骨效果。结果3周时实验侧缺损区可见成骨细胞和骨细胞,9周有大量的骨细胞和成骨细胞,对照侧仅见纤维组织充填;ALP活性及Ca^2＋含量实验侧均高于对照侧。结论rhBMP-2／卵磷脂复合材料具有良好的诱导成骨活性,生物相容性好。可降解,能够有效的提高ANFH的骨修复能力。     

缺血性股骨头坏死患者与正常受试者血浆糖盏蛋白水平的比较其临床意义

目的探讨缺血性股骨头坏死患者血浆糖盏蛋白水平的改变及其临床意义。方法检测在华中科技大学同济医学院附属协和医院骨伤科病房与门诊就诊的52例缺血性股骨头坏死患者和48名健康志愿者的血浆糖盏蛋白水平、血小板聚集率和纤维蛋白原含量,对每位受试者均做Harris评分。结果缺血性股骨头坏死患者血浆糖盏蛋白水平较正常人升高,血小板聚集率较正常人降低。血浆糖盏蛋白水平与股骨头坏死危险因素不相关,与Harris评分及纤维蛋白原呈正相关。血小板聚集率4 min和10 min时与纤维蛋白原正相关,2 min时与纤维蛋白原不相关。结论高含量纤维蛋白原促进糖盏蛋白的产生,其通过竞争性抑制血小板聚集缓解临床症状。血浆糖盏蛋白升高可能是缺血性股骨头坏死的一种自我保护机制。