股骨头缺血性坏死的DSA研究  

Selective Digital Subtraction Angiography in Avascular Necrosis of the Femoral Head

作　　者：王成纲[1] 朱亮[1] 任鹏 

机构地区：[1]天津医科大学附属石油医院

出　　处：《实用放射学杂志》1999年第2期66-68,78,共4页Journal of Practical Radiology

摘　　要：目的：通过股动脉数字减影血管造影（ＤＳＡ）探讨股骨头缺血性坏死（ＡＮＦＨ）的血液动力学改变及其在发病中的作用。方法：对９９例ＡＮＦＨ病人的１３２髋及正常对照１０个髋作了股动脉ＤＳＡ。Ⅰ期２髋，Ⅱ期３８髋，Ⅲ期５０髋，Ⅳ期４２髋，经对侧股动脉穿刺插入５Ｆ单弯Ｃ形导管，越过髂总动脉分叉，到达患侧股动脉。造影条件为碘必乐（３００ｍｇＩ／ｍｌ）每秒５ｍｌ，总量１２～１５ｍｌ连续减影至静脉期造影剂消失为止。结果：９９例的１３２髋中１３０髋（９８％）显示有股动脉造影的异常改变。动脉供血异常１０９髋，实质期股骨头染色７６髋，静脉系统异常４９髋。结论：ＡＮＦＨ股骨头血液动力学改变是复杂的，其发病机制不可能用单一的原因，如股骨头供血障碍，微循环血流瘀滞或静脉流出道阻塞加以解释；可能是由多种因素所致，多阶段发生的疾病。Objective:To evaluate the haemodynamic change and its role in the pathogenesis of avascular necrosis of the femoral head(ANFH)by selective digital subtraction angiography(DSA).Methods:Digital subtraction angiograms were performed in 132 hips of 99 patients with ANFH(2 hips had a stage Ⅰ,38 hips had a stage Ⅱ,59 hips had a stage Ⅲ,and 42 hips had a stage Ⅳ)and 10 normal hips through transfemoral approach and traversing the aortic bifurcation,the catheter advanced into the contralateral femoral artery.Iopamiro(300 mgI/ml)was injected at rate of 5 ml per second for a total volume of 12～15 ml.Subtraction was continued up to disappearance of the contrast medium.Results:DSA demonstrated abnormal findings in 130(98%)of 132 hips with ANFH:(1)The blood supply to femoral head was impaired in 109 hips;(2)In the paranchymal phase of DSA the femoral head was blushed in 76 hipa;(3)Abnormal changes of venous system were observed in 49 hipa.Conclusion:The haemodynamic change in ANFH is complex.It can not explain the pathogenesis of the disease with a single cause of impaired blood supply to the femoral head,intraossesous microvalcular stasis or blockage of the venous outflow.It is likely that multifactor plays a role in the development of osteonecrosis,which is a multiphased episodes of the condition.

关 键 词：股骨头坏死 数字减影 血管造影 ANFH 缺血性 

分 类 号：R681.804[医药卫生—骨科学] R816.8[医药卫生—外科学]