摘要
目的:观察不同国际骨循环研究协会(ARCO)分期、不同病因、不同坏死部位及范围非创伤性股骨头坏死(ONFH)的血运特点。方法:回顾性分析2018年1月至2023年12月于中国中医科学院望京医院接受数字减影血管造影(DSA)检查的58例(71髋)非创伤性ONFH患者的临床资料,根据旋股内侧动脉分出的上、下支持带显影情况将患髋分为3种类型:DSAⅠ型为上、下支持带动脉均显影或仅上支持带动脉显影;DSAⅡ型为上支持带动脉不显影,仅下支持带动脉显影;DSAⅢ型为上、下支持带动脉均不显影。同时记录上、下支持带动脉进入股骨头内的血管总数目。比较ARCOⅡ期与Ⅲ期、不同病因、不同坏死部位及范围ONFH患髋中各DSA分型占比差异以及上、下支持带动脉进入股骨头内的血管总数目差异。结果:ARCOⅡ期与Ⅲ期患髋中DSA分型差异有统计学意义(χ2=6.757,P=0.037);ARCOⅢ期患髋上、下支持带动脉进入股骨头内的血管总数目多于ARCOⅡ期患髋,差异有统计学意义(Z=-2.068,P=0.039)。不同病因、不同坏死部位、不同坏死范围ONFH患髋中DSA分型及上、下支持带动脉进入股骨头内的血管总数目差异均无统计学意义(P均>0.05)。结论:ONFH发生后,随着修复反应的启动,股骨头的血运可能会得到逐步改善,ARCOⅢ期患髋的股骨头血运优于ARCOⅡ期。此外,不同病因非创伤性ONFH中血运无明显差异,非创伤性ONFH坏死部位及范围与缺血支持带动脉间亦无明显对应关系。
Objective:To observe the blood supply characteristics in non-traumatic osteonecrosis of the femoral head(ONFH)across different Association Research Circulation Osseous(ARCO)stages,etiologies,and necrotic sites.Methods:A retrospective analysis was conducted on clinical data from 58 patients(71 hips)with non-traumatic ONFH who underwent digital subtraction angiography(DSA)in Wangjing Hospital of China Academy of Chinese Medical Sciences from January 2018 to December 2023.Based on the visualization of the superior and inferior retinaculum of the medial femoral circumflex artery,the affected hips were classified into three types:DSA type Ⅰ,both the superior and inferior retinacular arteries visualized or only superior arteries visualized;DSA type Ⅱ,only the inferior retinacular arteries visualized;DSA type Ⅲ,neither the superior nor inferior retinacular arteries visualized.The total number of vessels entering the femoral head from the superior and inferior retinacular arteries was recorded.Comparisons were made between ARCO stage Ⅱ and stage Ⅲ patients,as well as between patients with different etiologies,different necrotic sites,and ranges of non-traumatic ONFH,regarding the differences in the proportions of DSA types and the total number of vessels entering the femoral head from the superior and inferior retinacular arteries.Results:The proportion of DSA type Ⅰ in ARCO stage Ⅲ hips was higher than that in ARCO stage Ⅱ hips,while the proportion of DSA type Ⅲ was lower in ARCO stage Ⅲ hips than that in ARCO stage Ⅱ hips,and the difference was statistically significant(χ^(2)=6.757,P=0.037).The total number of vessels entering the femoral head from the superior and inferior retinacular arteries in ARCO stage Ⅲ hips was more than that in ARCO stage Ⅱ hips,and the difference was statistically significant(Z=-2.068,P=0.039).There was no significant difference in the proportion of DSA types and total number of vessels entering the femoral head from the superior and inferior retinacular arteries between ONFH hips with different etiologies,different necrotic sites,and different necrotic ranges(all P>0.05).Conclusions:After the occurrence of ONFH,the blood supply of the femoral head may gradually improve with the initiation of the repair response.The blood supply of the femoral head in ARCO stage Ⅲ hips is better than that in ARCO stage Ⅱ hips.In addition,there is no significant difference in blood supply between non-traumatic ONFH with different etiologies,and there is no obvious correlation between the necrotic site and range of non-traumatic ONFH and the ischemic retinacular arteries.
作者
张程
李龑
王均玉
刘道兵
谢斌
杨统杰
孙诗艺
陈卫衡
何海军
ZHANG Cheng;LI Yan;WANG Junyu;LIU Daobing;XIE Bin;YANG Tongjie;SUN Shiyi;CHEN Weiheng;HE Haijun(The Third Department of Orthopaedics,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China;Department of Minimally Invasive Arthropathy,the Third Affiliated Hospital of Beijing University of Chinese Medicine,Beijing 100029,China)
出处
《中华骨与关节外科杂志》
北大核心
2025年第5期422-428,共7页
Chinese Journal of Bone and Joint Surgery
基金
中国中医科学院望京医院高水平中医医院建设项目(WJYY-XZKT-2023-28)
北京市自然科学基金面上项目(7222298)。
关键词
股骨头坏死
数字减影血管造影
血运特点
Osteonecrosis of the Femoral Head
Digital Subtraction Angiography
Blood Supply Characteristics
