经髋部动脉灌注术治疗股骨头缺血性坏死的中远期临床疗效

目的:评价经髋部动脉灌注术治疗ANFH的中远期临床疗效。方法:随访研究经临床和影像学检查确诊并经髋部动脉灌注术治疗的100例(129髋)ANFH病人1-4年,按Ficat分期,0期0髋,Ⅰ期33髋,Ⅱ期68髋,Ⅲ期23髋,Ⅳ期5髋,比较治疗前后临床症状、髋关节功能及影像学改变。结果:经髋部动脉灌注治疗后1-4年的Ⅰ、Ⅱ期患者疼痛及生活能力较前改善(P<0.05),Ⅱ期患者关节活动度及行走距离较前改善(P<0.05);Ⅰ、Ⅱ期患者治疗后DSA显示血管增多,部分血管再通,实质期染色变化;MRI显示骨髓水肿信号及关节积液减少,骨坏死范围及坏死骨缩小;X线平片显示不同程度的骨质修复。Ⅲ、Ⅳ期患者治疗后1-3年临床症状、髋关节功能及影像学评价疗效不理想。结论:经髋部动脉灌注术治疗ANFH对Ⅰ、Ⅱ期患者有较好的中远期疗效,对Ⅲ、Ⅳ期患者中远期疗效不理想。

Avascular necrosis of the femoral head : evaluating the medium and long- term effect by transcatheter hip arteries perfusion with the TCM and western medicine

Objective: To evaluate the medium and long - term clinical effect of the ANFH by transcatheter hip arteries perfusion with the TCM and western medicine. Methods: Acoording to the Ficat system, 129 hips in one hundred ANFH patients were researched within 1 to 4 years follow - up, There are 0 hip at stage 0; 33 at stage Ⅰ; 68 at stage Ⅱ; 23 at stage Ⅲ; 5 at stage Ⅳ. The clinical symptoms 、 hip function and the changes of medical image were analyzed. Results: Within 1 to 4 years after transcatheter hip arteries perfusion, pain and viability of the patients at stages Ⅰ and Ⅱ were significantly improved after the therapy ( P < 0.05 ) ; the value of joints activity and walking distance of the patients at stage Ⅱ were increased after the therapy (P<0.05); DSA indicates blocked blood vessels were improved and part of them were recanalizated with blood vessels stain; MRI showed the decreasing signals of bone marrow oedema and effusion of joints, the decreasing scope of bone necroses and necrotic bones. The clinical symptoms、function and image evaluation of the hips at stages Ⅲ and Ⅳ after 1-3 years therapy were not significantly improved. Conclusion: Transcatheter hip arteries perfusion for ANFH has good mid - term and long - term therapy effect on the patients at stage Ⅰ and Ⅱ, but less effect at stage Ⅲ and Ⅳ.