摘要
目的探讨介入性溶栓联合冲击波修复重建骨组织结构治疗股骨头缺血性坏死的疗效。方法选择CR、MRI确诊的股骨头缺血性坏死92例,其中42例行介入溶栓联合体外冲击波治疗为联合治疗组,50例行单纯超选择介入性溶栓治疗为对照组。介入治疗采用经皮股动脉插管至患侧旋股内、外动脉,闭孔动脉缓慢注入尿激酶、罂粟碱、低分子右旋糖酐及654-Ⅱ,共治疗2～3次。介入治疗联合体外冲击波治疗采用介入性溶栓治疗间隙行体外冲击波治疗,冲击波治疗采用在X线透视以股骨头坏死区在体表投影为中心选取1～2个冲击点,每个冲击点每次冲击400～500次,共治疗3～5次,冲击波治疗采用能量密度0.18～0.25mJ/mm^2。治疗前、后3、6及12个月进行髋关节Harris评分(100分)。对两组治疗结果进行统计学分析。结果治疗后两组髋关节Harris评分较治疗前均有明显提高(P<0.01),联合治疗组明显高与对照组(P<0.05),联合治疗组髋关节Harris疗效:治愈12例,显效16例,有效11例,无效3例,总有效率93.2%;髋关节Harris评分等级:优7例,较好15例,良16例,差4例,优良率90.4%,与对照组比较有统计学意义(P<0.05)。结论介入性溶栓联合冲击波修复重建骨组织结构治疗股骨头缺血性坏死是一种创伤小、安全而疗效显著的治疗方法。
Objective To investigate the clinical efficacy of the interventional thrombolysis combined with ESW to reconstruct osseous tissue structure in the treatment of avascular necrosis of femoral head. Methods A total of 92 patients with avascular necrosis of femoral head involved were confirmed by CR or MRI examination. They were divided into 2 groups： group A （n=42） were treated with interventional therapy combined with ESW, and group B （n=50） were treated with simple interventional thrombolysis as a control group. In group B, Papaverine, Urokinase, low molecular dextran and 654-II were slowly injected into the medial and latemal femoral circumflex arteries and obturator artery by Seldinger puncture through supercatheterizing for 2 to 3 times. In group A, the focusing points of avascular femoral head necrosis on the surface projection were marked with X-ray fluoroscopy, and 1-2 points were selected for one treatment with 400-500 pulses in each point, with the energy density of ESW being 0.18-0.25mJ/mm2. Generally speaking, such treatment in group A was performed for 3 to 5 times. The Harris Hip Scores （HHS） were graded before and in 3, 6 and 12 months after the treatment. The results were compared statistically. Results Both groups showed an increase of their HHS after treatment in comparison with their scores before treatment （P〈0.01）, and group A were signifiantly higher than group B （P〈0.05）. The Harris efficacy results in group A suggested： cure （n=12）, significant efficacy （n=16）, fair efficacy （n=l 1）, no efficacy （n=3）. The overall effective rate was 93.2%. The HHS reported excellent （n=7）, good （n=15）, fair （n=16）, fail （n=4）. The overall excellent and good rate was 90.4%. Conclusions The interventional thrombolysis combined with ESW to reconstruct osseous tissue structure is a minimally invasive, safe thrombolysis and effective method in the treatment of avascular necrosis of femoral head.
出处
《中国骨肿瘤骨病》
2011年第3期231-235,共5页
Chinse Journal Of Bone Tumor And Bone Disease
关键词
股骨头缺血性坏死
介入溶栓治疗
体外冲击波
Avascular necrosis of femoral head
Interventional thrombolysis therapy
Extracorporeal Shock Wave （ESW）
