多功能SPECT显像监测股骨头减压+植骨诊疗早期股骨头缺血性坏死的临床探讨

目的探讨多功能SPECT在股骨头减压+植骨治疗早期股骨头缺血性坏死中的监测价值。方法对30例早期股骨头缺血性坏死患者(FicatⅠ～Ⅱ期)行股骨头减压+植骨术,于术前3 d、术后半个月、1个月、6个月行SPECT显像监测,在断层像上利用感兴趣区技术测定股骨头/干的放射性比值,将结果进行方差分析,并与30例健康者对比;于术后6个月采用Harris评分标准作疗效评定。结果与术前相比,术后半个月、1个月、6个月股骨头/干的放射性比值明显升高,差异非常显著(P<0.01);与健康组相比,术前明显降低,术后半个月、1个月明显升高,有非常显著差异(P<0.01);术后6个月与健康组水平相近,无显著差异(P>0.05)。术前Harris评分55～79分,平均66.23分;术后68～98分,平均85.47分,差异非常显著(P<0.01),其中优8例,良18例,可2例,差2例,优良率86.7%。结论股骨头减压+植骨治疗早期股骨头缺血性坏死疗效可靠,多功能SPECT显像可为评价早期股骨头缺血性坏死的治疗效果提供可靠的客观依据。

Clinical Study of Multifunctional SPECT Monitoring Value in Treating Early Avascular Necrosis of Femoral Head by Drilling Decompression and Bone Graft

Objective To study the monitoring value of multifunctional SPECT in treating early avascular necrosis of femoral head(ANFH) by drilling decompression cooperated with bone graft.Methods 30 cases of early ANFH(in Ficat stages Ⅰ~Ⅱ) received drilling decompression cooperated with bone graft operation.SPECT examination were performed at 3 days preoperation,half a month,1 month and 6 months postoperation.The nuclide uptake ratio of femoral head and femoral diaphysis(H/F) was calculated on bone tomography by using the region of interest technology(ROI).The results of H/F were treated by analysis of variance and were contrast with 30 cases of health.The evaluation criteria of Harris hip score was taken to value the therapeutic effect at 6 months postoperation.Results Compared with 3 days preoperation,H/F at half a month,1 month and 6 month postoperation was much higher.Compared with the health,H/F at preoperation were much lower,half a month and 1 month postoperation were much higher,there were significant differences(P<0.01) between them;but there were no significant differences(P>0.05) between the 6 months postoperation and the health.The Harris hip scores improved from 55~79 preoperation(averaged 66.23) to 68~98 postoperation(averaged 85.47),there were significant differences(P<0.01) between them.Among them was excellent in 8 cases,good in 18 cases,fair in 2 cases,bad in 2 cases.The excellent and good rate was 86.7%.Conclusion The therapeutic effect of drilling decompression cooperated with bone graft operation is reliable in treating early ANFH.Multifunctional SPECT can give a reliable objective basis for estimation of the therapeutic effect of ANFH treated by drilling decompression cooperated with bone graft.