骨显像诊断股骨头缺血性坏死

目的：了解三相骨显像对于股骨头缺血性坏死的诊断价值。方法：出院诊断为股骨头缺血性坏死患者31例（36个坏死股骨头），多次门诊后确诊为股骨头缺血性坏死患者17例（20个坏死股骨头），共计48例56个缺血性坏死股骨头，对其进行^99Tc^m-MDP三相骨显像。其中31例36个坏死股骨头有近期X线片检查结果，列表与骨显像结果作了对照。结果：56个缺血性坏死股骨头静态骨显像均有相关坏死征象，血流相37个有改变（66．1％），血池相40个有改变（71．4％）。36个坏死股骨头X线片结果为正常者10个（27．8％），早期坏死7个（19．4％），坏死19个（52．8％），诊断灵敏性低于骨显像。结论：三相骨显像对诊断股骨头缺血性坏死是一个准确、灵敏而简便的方法，可作为常规应用。     

核素因子分析显像对早期股骨头缺血性坏死的诊断价值

目的 :探讨核素因子分析显像方法对早期成人股骨头缺血性坏死的诊断价值。方法 :对 1 0例 2 0髋正常股骨头和 1 5例 1 8髋早期股骨头缺血性坏死进行核素因子分析显像 ,并与骨三相、SPECT进行了比较。结果 :AFHIN早期骨因子图像明显比正常股骨头影浓聚 ,其因子曲线呈缓慢上升趋势 ,而软组织和血因子图像及其因子曲线无明显异常。核素因子分析显像对早期AFHIN的诊断率为1 0 0 % ,明显高于SPECT(83 % )和骨三相 (72 % )。结论 :核素因子分析显像对早期诊断AFHIN具有很高的灵敏性 ,值得在临床上推广应用。     

放射性核素骨显像诊断股骨头缺血性坏死的临床观察

作者应用放射性核素骨显像对45例股骨头缺血性坏死的患者进行了检查,并经手术和临床随访证实,其灵敏度为93.7％;准确性为93.3％;特异性为92.6％。本法诊断结果与同期X线片诊断结果进行了比较,差异有高度显著性意义(P<0.01)。认为核素骨显像是一种早期诊断股骨头缺血性坏死灵敏、准确的方法。     

股骨头缺血性坏死早期影像学分析

目的探讨股骨头缺血性坏死(AVN)的早期影像学诊断。方法收集31例AVN的髋关节均作SE序列T1、T2加权横断及冠状位成像、SPECT骨显像、CT、X线片进行综合分析。结果AVN早期90%髋关节腔内有Ⅱ～Ⅲ级的液体。骨显像是异常浓集区,CT表现为股骨头皮质厚薄不均,骨小梁紊乱、增粗,星芒征变形,头关节面边缘轻度增生。X线片系小部分异常。结论在AVN的早期病例中,MRI是显示关节液体最敏感的方法,骨显像表现为“异常浓集”,对诊断具有重要意义。CT对AVN的早期诊断价值也得到肯定。     

CT在股骨头缺血性坏死检查中的价值(附31例分析)

目的探讨CT在股骨头缺血性坏死检查中的价值。方法将31例股骨头缺血性坏死患者的CT与X线平片表现进行对照分析。结果：4例处于Ⅰ期患者CT表现异常征象，但X线未显示异常。结论CT有利于早期诊断股骨头缺血性坏死，在检查股骨头缺血性坏死方面能发挥重要的辅助作用。     

股骨头缺血性坏死早期诊断的对比研究

目的 :讨论早期股骨头缺血性坏死的诊断方法。方法 :回顾性对比分析 12例 16髋股骨头缺血性坏死的X线片、CT扫描、及ECT检查的诊断价值。结果 :X线片、CT及ECT检查的敏感度分别为 18.8%、43 .8%及 87.5 % ,X线、CT及ECT检查的准确性分别为 45 .8%、68.5 %及 91.7%。结论 :ECT是早期诊断股骨头缺血性坏死的满意方法。     

介入治疗髓芯减压加植骨术治疗股骨头坏死

目的探讨采用介入治疗、股骨头髓芯减压加植骨术治疗早期股骨头缺血性坏死的疗效。方法2001年5月至2004年6月,采用介入治疗、股骨头髓芯减压加植骨术治疗F icatⅠ~Ⅲ期股骨头缺血性坏死25例42髋,其中男18例,女7例;年龄25~54岁。术前疼痛时间4~12个月,平均6个月。所有患者于术后3个月和6个月行双髋关节X线片及CT检查。结果所有病人随访6~36个月,平均22.5个月。21例病人症状明显缓解,H arris评分从术前平均76分升至术后93.4分。22例病人X线片显示髋关节保持基本生理形态,无明显坏死进展,3例4髋症状加重。结论介入治疗、股骨头髓芯减压加植骨术治疗早期股骨头缺血性坏死较其他方法,手术损伤小,术后关节功能恢复快,临床症状明显改善,短期疗效满意。     

微创减压加打压植骨治疗股骨头坏死的临床应用研究

目的:探讨一种简单有效治疗股骨头缺血性坏死的新方法,以保护髋关节,改善临床症状。方法:2003年3月至2008年4月治疗股骨头缺血性坏死患者55例(手术61髋),男37例,女18例;年龄12～55岁,平均39.8岁;病史8个月～16年。采用髋关节部分滑膜切除,股骨头微创减压加打压植骨联合手术治疗股骨头缺血性坏死,从术前、术后X线片的股骨头塌陷程度和髋关节功能Harris评分两方面对疗效进行评价。结果:共治疗股骨头无菌性坏死55例(61髋),随访6个月～5年,平均2.2年。X线片显示未发生塌陷或塌陷无加重的39髋,11髋塌陷加重不超过2mm,9髋塌陷2～4mm,2髋塌陷加重超过4mm。术前Harris评分平均(59.74±11.56)分,术后平均(89.75±9.58)分,术后比术前得分明显提高(t=2.3461,P0.05)。按Harris疗效评价标准:优31髋,良22髋,可6髋,差2髋。结论:采用微创减压加打压植骨治疗股骨头无菌性坏死能够减少股骨头的应力负荷,稳定股骨头的内环境,有利于骨坏死修复,可有效预防股骨头坏死塌陷。适用于FicatⅡ、Ⅲ期股骨头坏死的患者,尤以中青年患者为宜。     

缝匠肌髂骨瓣移植术治疗青中年人股骨头缺血性坏死疗效观察

目的　探讨和总结青中年股骨头坏死的最佳治疗方案。方法　于股骨头颈部开槽进入股骨头病灶处 ,彻底清除硬化、囊变病灶和充分减压 ,同侧缝匠肌髂骨瓣植骨术治疗青中年股骨头缺性坏死 36例。结果　对 36例病人经 6个月～ 8年 ,平均 5 1个月的随访 ,按王岩股骨头缺血坏死疗效评价法判定 ,临床优良率 90 %以上 ,X线股骨头修复率 80 %以上。结论　该方法具有清除病灶彻底、减压充分 ,重建股骨头的血液循环等特点 ,缝匠肌髂骨瓣植骨为股骨头带入成骨效应成分 ,加速骨的重建 ,适用于青中年股骨头缺血性坏死Ⅰ、Ⅱ、Ⅲ期患者 ,是一种较理想的治疗方法。     

股骨头髓心减压加异体腓骨移植术治疗股骨头坏死

目的探讨股骨头髓心减压加异体腓骨移植术治疗早期股骨头缺血性坏死的疗效。方法1998年6月～2004年8月，采用股骨头髓心减压加异体腓骨移植术治疗Ⅰ～Ⅲ期股骨头缺血性坏死22例39髋，其中男17例，女5例。年龄22～60岁。术前疼痛时间2～12个月，平均6、5个月。所有患者于术前及术后15d，3个月和6个月行双髋关节功能、常规X线片、ECT、CT和MRI检查。结果患者均获随访3～74个月，平均31．4个月。17例临床症状缓解明显，Harris评分从术前平均78分升至术后91．6分。18例X线片显示髋关节形态基本保持完好，无明显坏死进展。ECT、CT和MRI检查均见植骨成骨征象。有2例4髋于1年半后改行人工全髋关节置换术。另有3例4髋症状有所加重，但未行人工关节置换术。结论股骨头髓心减压加异体腓骨移植术治疗早期股骨头缺血性坏死，手术损伤小，术后关节功能2～4周即可恢复或超过术前水平，临床症状改善。其短期疗效肯定，中长期疗效仍需进一步观察。     

Necrosis of the proximal epiphyseal plate cartilage of the femur following detachment of the perichondral ring. Its relationship to the etiology of proximal epiphysiolysis of the femur

A histological study of the proximal epiphyseal plate cartilage of rabbit femurs following detachment of the perichondral ring was performed. 15 animals were used, 5 of which being controls. Slight to severe necrotic changes in the plate were present in 9 out of 10 animals. In severe necrosis there was formation of fissures similar to those seen in human femoral epiphysiolysis. The necrosis was considered ischemic in nature and due to the detachment of the perichondral ring with involvement of the blood supply for the femoral epiphysis. Also the epiphyseal and metaphyseal bone marrow and bone tissue, as well as the articular cartilage, presented necrotic changes in a few animals. Such necrosis of the epiphyseal plate may be a factor in the pathogenesis of human proximal epiphysiolysis of the femur.     

Development of flattening and apparent fragmentation following ischemic necrosis of the capital femoral epiphysis in a piglet model

BACKGROUND: The repair response that follows ischemic necrosis of the immature femoral head and the biological processes that are responsible for the development of femoral head deformity and fragmentation have not been clearly defined. A piglet model was used to study the radiographic and histopathologic changes that occur prior to and during the development of femoral head deformity and fragmentation following ischemic necrosis. METHODS: Twenty-five male piglets were studied. A nonabsorbable ligature was placed tightly around the femoral neck to disrupt the blood supply to the capital femoral epiphysis. The animals were killed three days to eight weeks following the induction of ischemia. Radiographs of whole and sectioned femoral heads were made, and the radiographic findings were correlated with the histopathologic changes observed in the specimens. RESULTS: Mild femoral head flattening was observed by four weeks after the induction of ischemia, and severe flattening and fragmentation were observed by eight weeks. The predominant repair response observed following revascularization was osteoclastic bone resorption. Prior to the development of flattening, a large area of osteoclastic bone resorption was observed in the central region of the femoral head. Many osteoclasts were present along the revascularization front, which we believe were responsible for active resorption of the necrotic trabecular bone. Appositional new-bone formation, the hallmark of the repair response in adult ischemic necrosis, was not observed in the area of bone resorption. Instead, the areas of resorbed bone were replaced with a fibrovascular tissue that persisted for up to eight weeks. Appositional new-bone formation was observed, but it was limited to small areas in which revascularization was not followed by osteoclastic bone resorption and in which necrotic trabecular bone was still present. The simultaneous presence of the areas of bone resorption and new-bone formation contributed to the fragmented radiographic appearance of the femoral head. CONCLUSIONS: The predominant repair response observed in the piglet model of ischemic necrosis was osteoclastic bone resorption. The early bone loss, the lack of new-bone formation, and the persistence of fibrovascular tissue in the areas of bone resorption compromised the structural integrity of the femoral head and produced progressive femoral head flattening over time. The repair response was different from that observed in femoral heads removed from adult patients with ischemic necrosis and from that observed in the adult rabbit model of ischemic necrosis. Clinical Relevance: The piglet model of ischemic necrosis may be useful for the investigation of the biological processes that lead to the development of femoral head deformity following ischemic necrosis of the immature femoral head.     

特发性股骨头缺血坏死的病理变化及发病机制探讨

目的：观察特发性股骨头缺血坏死（ANFH）的病理变化，探讨脂肪栓子及微血栓，分坏死原因。方法：34个特发性ANFH的股骨头，采用苏木素－伊红、脂肪、微血栓和弹力纤维染色方法，光镜下观察股骨头内各部位的坏死和修复情况，确定脂肪栓子和微血栓的形态和分布状态。结果：坏死股骨头内骨髓细胞减少，脂肪组织增多，脂肪细胞肥大。血管中有大量脂肪栓子和微血栓，19个股骨头内发现脂肪栓子，21个发现微血栓，在1例中显示骨髓内脂肪滴正从静脉破裂口进入静脉内。结论：脂肪栓塞是ANFH的重要原因，骨髓脂肪滴进入血管可能起动了ANFH并维持其发展。     

开窗病灶清除植骨术治疗股骨头缺血性坏死

目的　寻求治疗股骨头缺血性坏死的简便而有效的手术方法。方法　设计一种于股骨头颈交界处开窗、坏死骨清除减压、髂骨松质骨填充植骨术 ,术后配合牵引髋关节 ,早期持续被动功能锻炼的方法 ,治疗股骨头缺血性坏死 2 0例 2 9个股骨头。结果　 2 0例 2 9个股骨头经 1～ 3年随访 ,效果满意。髋痛消失 ,髋关节功能良好 ,行走及下蹲正常或基本正常。结论　此术式可彻底清除坏死骨 ,消除血供障碍因素 ,为重建血运修复骨质创造条件 ,在病灶清除后的股骨头空腔内 ,填充大量松质骨支撑软骨面 ,为骨修复提供成骨条件。早期髋关节持续被动功能锻炼对关节软骨的修复和预防关节粘连是极为有利的。此法操作简便 ,创伤小 ,效果好。     

Chondrolysis in rats with vascular deprivation - induced oisteonecrosis of the femoral neck

This report describes an animal model of chondrolysis, i.e., acute necrosis of the articular cartilage. The blood circulation of rats' femoral heads was disrupted by incising the periosteum at the base of the femoral neck and cutting the ligamentum teres. The joint cartilage was necrotic in 18 of the 30 and 21 of the 39 osteonecrotic femoral heads of rats killed on the 30th and 42nd postoperative day, respectively. Chondrolysis was limited to the superficial cartilage layer in mild cases. It involved the entire cartilage in the more severely affected instances. Chondroclasts abutted on the necrotic cartilage where fibrous tissue replaced the subchondral bone plate. At the most advanced stage, the cartilage was segmentally absent, polished bone constituting the articular aspect. Chondrolysis, rarely detected in otherwise healthy children, commonly occurs in patients with a slipped capital femoral epiphysis, a disorder commonly associated with osteonecrosis of the femoral head. The herein presented model may serve the study of necrosis of the cartilaginous and osseous compartments of the femoral head in a small laboratory animal.     

钛合金支撑架植入治疗股骨头缺血性坏死的动物实验研究

[目的]通过动物模型,观察支撑架置入治疗狗股骨头缺血性坏死的疗效。[方法]本研究设计一种中空多孔圆柱状带螺纹的钛合金支撑架,选用成年杂种狗15只,用液氮冷冻法制造股骨头坏死模型,通过中心减压钻隧道至股骨头坏死区软骨下骨,然后沿隧道拧入支撑架。术后分期处死,取标本观察相关指标。[结果]术后无1例发生股骨头塌陷,X线片显示支撑架位置良好,组织学观察显示术后坏死股骨头得以逐步重建,再生的松质骨小梁能够长入支撑架中并改建、修复、替代股骨头内坏死的骨组织,形成穿越支撑架网孔的网状松质骨结构。[结论]利用多孔中空支撑架给股骨头坏死区软骨下骨板提供支撑,防止股骨头塌陷。多孔网状结构容许松质骨的长入和爬行替代,对治疗狗股骨头坏死有明显疗效。提示钛合金支撑架可用于股骨头坏死的治疗。     

Failure of free vascularized fibular graft for osteonecrosis of the femoral head: a histopathologic study of 6 cases

The rationale for the use of free vascularized fibular graft for osteonecrosis of the hip is based on the assumption that the graft will provide support and blood supply to the osteonecrotic head. We report the histopathologic features of 6 consecutive osteonecrotic heads with failed vascularized fibular grafts. Three grafts were partially viable, and 3 were necrotic. The medullary canal was completely necrotic in 4 grafts. A thin layer of new, viable periosteal bone and bone remodeling was present at the surface of 4 grafts. New bone applied to the surface of the graft, especially in the 3 necrotic ones, suggests that the new bone originated from the host bed and not from the graft. Therefore, the risks and benefits of the vascular anastomosis, which in these cases provided no viability to the graft, should be re-evaluated. These findings were observed in failed cases and cannot be extrapolated to successful ones.     

Magnetic resonance imaging in the early diagnosis of ischemic necrosis of the femoral head. Preliminary results

Magnetic resonance imaging (MRI) was performed on the hips of 25 patients with suspected ischemic necrosis of the femoral head. Twenty-six femoral heads manifested MRI changes of ischemic necrosis: diminished bone marrow signal in a ringlike, focal, or diffuse pattern. Plain radiographs were normal in 13 of 26 MRI-positive hips; six were asymptomatic. MRI was more effective in detecting early cases than conventional 99mTc-diphosphonate or 99mTc-sulfur colloid (SC) bone scanning. There were no false-negative MRI examinations, but diphosphonate scans were negative in nine hips with normal radiography and abnormal MRI. Sulfur colloid scans were normal in only two hips with positive MRI, but SC scan results were often equivocal because isotope deficits were bilaterally symmetric. The results of this preliminary investigation imply that MRI has extraordinary sensitivity for the detection of early ischemic necrosis. Unlike radionuclide scanning, MRI shows the exact location and extent of femoral head necrosis. Because MRI is expensive, it should be used in a cost-effective manner. Therefore, MRI is best suited for the diagnosis of early cases where less expensive tests are negative or equivocal and as a precursor to more costly interventional procedures, such as core biopsy study or decompression.