股骨头缺血性坏死多层螺旋CT三维构筑及介入治疗的临床意义  

Dual Source CT of Three Dimensional Dnilding and Clinical Significance of Interventional Treatment for Avascular Necrosis of the Femoral Head

作　　者：刘宏滨[1] 王建国[2] 史跃[3] 赵汉青[3] 朱丽丽[3] 王安明[3] 张传开[1] 陈启忠[1] 

机构地区：[1]中国人民解放军第九七医院骨科,江苏徐州221004 [2]江苏省沭阳县人民医院介入放射科 [3]中国人民解放军第九七医院医学影像科

出　　处：《解剖与临床》2012年第3期213-216,共4页Anatomy and Clinics

基　　金：南京军区医学科技创新课题（11MB007）

摘　　要：目的：探讨采用多层螺旋cT对股骨头缺血性坏死进行三维立体构筑的技术方法及介入治疗的临床价值。方法：使用SiemensSomatomDefinition64层螺旋CT对31例股骨头缺血性坏死患者共36髋进行薄层扫描，利用Inspace软件和NeuroDSA软件进行影像重组和三维立体构筑，并在X、Y和z轴上旋转，观察股骨头的解剖形态。对I期坏死患者采用单纯经股骨头供血动脉灌注扩张血管及溶栓药物进行介入治疗；对II期及股骨头外形完整的III期患者首先采用介入治疗，然后经环钻剜出坏死骨植入混合自体骨髓间充质干细胞的自体松质骨。结果：容积重组图像显示早期缺血坏死的股骨头解剖形态基本正常，股骨头表面可见凹凸不平。股骨头坏死区的体积I期（8髋）为（1218．97±449．93）mm3，II期（22髋）为（3671．19±1316．83）mm3，股骨头完整的III期（6髋）为（7874．18±2381．22）mm3。根据HHS评分，疗效优23髋（63．89％），良10髋（27．78％），可3髋（8．33％），差0髋。结论：多层螺旋CT三维重组技术能够立体构筑股骨头的解剖形态，并在不同层面上对坏死区的大小进行测量，对股骨头缺血性坏死患者治疗方法的选择具有重要的临床指导意义。Objective：To explore the use of multi - slice spiral CT in avascular necrosis of the femoral head to build a three - dimensional techniques and it＇ s clinical value. Methods ： To use Siemens Somatom Definition 64 - slice spiral in 31 cases with avascular necrosis ,altogether 36 hips on thin layer scanning, Inspace software and NeuroDSA software were used for image restructuring and three dimensional construction, and rotation was conducted in the X, Y and Z axis. The femoral head anatomical configuration was observed. Patients with stage I necrosis performed the simple femoral head blood artery perfusion the dilation of blood vessels and thromholysis drug for intervention ; for patients of stage II and patients of stage III with the complete femoral head were firstly performed the interventional therapy, then by HuanZuan gouged out the necrotic bone implant autologous mesenchymal stem cells and autogenous cancellous bone. Results：The volume restructuring image showed avascular necrosis of the femoral head with normal anatomy. Femoral head was uneven surface. Phase I （ 8 hips） of the volume of femoral head necrosis was （ 1218.97 ± 449.93 ） mm3, Phase II （22 hips） of the volume of femoral head necrosis was （3671. 19 ± 1316.83 ）mm3. Complete Phase III （6 hips） of femoral head necrosis volume was （7 874.18 ± 2 381.22）mm3. After treatment, HHS evaluation was excellent in 23 hips, accounting for 63.89% ; HHS evaluation was pretty good in 10 hips, accounting for 27.78% ; HHS evaluation was good in 3 hips, accounting for 8.33% ; no poor ttHS evaluation of these hips. Concluslons：The three - dimensional restructuring technology of the MSCT can build the femoral head three - dimensional anatomical configuration and measure different levels of necrosis of the femoral head. The avascular necrosis treatment methods selection has important clinical significance.

关 键 词：股骨头缺血性坏死 三维重建 解剖学 介入治疗 

分 类 号：R681.8[医药卫生—骨科学] R445[医药卫生—外科学]