股骨头坏死术前术后DSA评价

目的：通过对股骨头坏死病例术前术后行DSA检查,了解其术前股骨头血供情况,评价术后疗效。方法：对55例股骨头坏死病例行DSA检查。手术前病例25例,其中FicatⅡ期10例、Ⅲ-Ⅳ期15例,均伴髋关节异常。手术后30例,其中大转子转移股骨头成形术15例,带血管蒂髂骨骨瓣移植髓腔减压术15例。所有患者均选择旋股内外血管造影。结果：术前25例患者中20例旋股内动脉终末支中断、消失,3例股骨头染色良好,2例支持带动脉正常;25例均未见髋部静脉显影。术后30例髋部动脉造影示全部病例随手术方式不同出现髋部动脉发生解剖性变化,股骨头圆韧带动脉均未见显示。结论：股骨头坏死术前DSA造影可准确判断病侧股骨头动脉供血情况,对确定手术方式具有指导意义。手术后DSA造影对判断疗效具有重要价值。

Evaluation on therapeutic efficacy regarding the necrosis of femoral head by digital subtraction arteriography

Objective： To comprehend the preoperative blood supply for femoral head and evaluate the postoperative curative effects,through digital subtraction arteriography（DSA） performed on the patients with necrosis of femoral head（NFH） before and after operations.Methods： 55 cases of NFH included 25 preoperative cases and 30 postoperative cases,the former was consisted of 10 cases of stage Ⅱ of FNH,15 stage Ⅲ-Ⅳ,according Ficat classification,all these patients were combined with abnormal hip joints;the latter included 15 cases with vascularized greater trochanter flap and other 15 cases with vascularized iliac bone flap and decompression of pulp cavity.All the patients accepted DSA through their medial and lateral circumflex femoral arteries.Results： The DSA of 25 preoperative cases showed that 20 case with disappearance or broken terminal branches of medial circumflex femoral arteries,3 cases with femoral head were dyed well,2 cases with normal retinacular artery,25 cases with no visualization of veins in hip.The DSA of 30 postoperative cases showed that there were some anatomic changes of arteries in hip along with various modus operandi,without visualization of arteries supplying for round ligament of femur in 30 cases.Conclusions： The DSA before operation could exactly show exact blood supply for the necrotic femoral head,could provide guidance for choosing modus operandi.The DSA after operation plays an important role in judgement of curative effect.