21例股骨头坏死的介入治疗

目的探讨股骨头缺血性坏死(ANFH)的介入治疗效果。方法对21例ANFH患者的25髋先常规行X线平片、MRI、股动脉DSA,后在股骨头的供血动脉旋股内、外侧动脉内灌注溶栓、扩血管药物,即在每支血管内注入稀释后的罂粟碱25 mg、尿激酶25万u、低分子右旋糖酐80 ml、血栓通0.15 mg;术后每日静脉滴注低分子右旋糖酐500 ml、血栓通0.3 mg及肝素钠4 500 u,连用5 d,治疗后行股骨头X线平片及MRI、股动脉DSA,随访1年以评估疗效。结果术后患者患髋疼痛症状明显减轻,关节功能不同程度改善,随访6～12个月(平均10.0个月),股骨头X线平片及/或CT示FicatⅠ、Ⅱ期患者介入治疗后股骨头修复明显。结论股骨头供血动脉内的介入治疗是一种疗效肯定、安全的方法。

INTERVENTIONAL THERAPY OF 21 CASES ISCHEMIC NECROSIS OF FEMORAL HEAD

Objective To study the curative effect of interventional thrombolysis on ischemic necrosis of femoral head. Methods Applying Seldinger′s technique,the catheter was guided via arterial femoralis with super-selection into circumflexafemoris medialis,lataralis,and acetabuli to perform the interventional thrombolysis in 21 cases（25sides） with necrosis of femoral head. Results All patients were followed-up for 6~12 months,combined with angiography,to observe the clinical symptoms and the change of bone.The curative effect was evaluated.The ratio of the improvement of clinical symptom was 80%.72% of the necrotic area of femoral head showed hyperplasia,sclerosis,and reduction of cystic changes. Conclusion The interventional therapy by leading to target vessel with thrombolysis in treating necrosis of femoral head has remarkable therapeutic effect.