股骨头无菌性坏死的介入治疗

目的 评价经动脉介入法和介入置管法对股骨头无菌性坏死（ANFH）的治疗作用。方法 经临床、X线平片、CT域RI检查证实的ANFH 30例，经动脉介入治疗法采用Seldinger技术，插至患侧旋股内、外动脉开口，灌注溶栓剂、解痉剂及血管扩张剂；介入置管法为骨穿刺针在X线监视下从股骨大粗隆稍下方进针，进入股骨头坏死区，旋转硬膜外导管，然后灌注上述相同药物，疗效评定标准：治疗前后动脉数目和静脉回流的变化；临床症状的改变；定期X线摄片随访。结果 动脉数目的变化：9例行介入置管法，治疗后7例静脉回流通畅；2例静脉回流稍通畅。临床症状的变化：经动脉介入治疗的21例，除2例未做治疗后的第2次动脉造影，另19例治疗后动脉数目增多10例、有所增多5例、不增多4例；静脉回流的变化：9例行介入置管法，治疗后7例静脉回汉通畅；2例静脉回流稍通畅。临床症状的变化：21例行经动脉介入治疗后疼痛改善14例、缓解4例，未改善3例。9例行介入置管治疗后疼痛改善6例、缓解3例。X线下片复查：于治疗后1年复查，21例行经动脉介入治疗者，14例复查显示10例有不同程序的骨质修复；9例行介入置管治疗者，5例复查显示4例有不同程度的骨质修复。结论 经动脉和介入置管治疗ANFH，对改善局部血液循环，促进股骨头的新生骨形态及修复起到了重要作用。

Interventional Therapy for Avascular Necrosis of the Femoral Head

Purpose To evaluate the clinical effecacy of interventional therapy for treatment of avascular necrosis of the femoral head (ANFH) with two methods, that is catheterizing medial and lateral femoral circumflex arteries and placing catheter into osteonecrosis of the femoral head. Methods 30 patients are diagnosed on the basis of MRI, CT, radiographs and clinical symptom, they are therapied by catheterizing medial and lateral femoral circumflex arteries, and placing catheter into osteonecrosis of the femoral head perfused with thromolytic agents, vasodilator drugs, drugs improving microcirculation.Criteria of curative effect:the chang of arterial numbers,venous return volume and clinical symptom. Follow up with X ray radiograph before and after therapy. Results Hip pain and disorders of joint function are alleviated and improved in different degrees after treatment with catheterizing medial and lateral femoral head for 9 patients. Arteriography demonstrate veinous return promoted for 9 patients as compared with that before treatment. With following up one year, radiographs shows repair of the femoral head in different degrees for 10 patients with catheterizing medial and lateral femoral circumflex arteries and for 4 patients placing catheter into osteonecrosis of the femoral head. Conclusion Two interventional therapies have provided and improving effect for the blood supply and promoting repair of the femoral head, being safe and effective methods. [