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目的探讨经导管超选择血管内介入治疗儿童股骨头骨骺缺血性坏死的临床疗效及影像学评价。方法对我院2010年9月至2011年4月收治的30例股骨头骨骺缺血性坏死患儿,采用Seldinger技术经对侧股动脉穿刺插管超选择行患侧旋股内、外动脉和闭孔动脉造影,分别采用尿激酶4～5千U、低分子右旋糖酐40 ml作局部灌注,再行造影,观察治疗后的影像学变化。21例需行第二次治疗。治疗结束后评定治疗效果,并行股骨头X线平片或CT、MR随访评估疗效。结果 DSA显示治疗后所有患者股骨头区血管计数较治疗前增加,股骨头染色增强;24例患髋疼痛症状明显减轻,跛行明显改善,治疗总有效率80%,无不良反应和并发症发生。影像学检查发现病侧股骨头塌陷变凸、死骨吸收、新骨形成。结论患儿骨质生长处于旺盛期,超选择血管内介入治疗股骨头骨骺缺血性坏死是一种创伤小、安全、并发症少、疗效肯定的方法,关节功能及股骨头形态均得到不同程度的改善。
Objective To investigate the clinical efficacy and imaging evaluation of transcatheter superselective endovascular intervention for avascular necrosis of the femoral head epiphyseal in children. Methods Thirty cases of ischemic necrosis of the femoral head epiphyseal treated in our hospital from September 2010 to April 2011 were treated with Seldinger technique. The lateral and lateral femoral circumflex femoral artery Obturator arterial angiography, respectively, urokinase 4 ~ 5 U, low molecular weight dextran 40 ml for local perfusion, and then angiography to observe the imaging changes after treatment. 21 cases need to be the second treatment. After the treatment, the curative effect was evaluated, and the follow-up of X-ray and CT and MRI of femoral head was performed. Results DSA showed that the blood vessel count of the femoral head area in all the patients was increased before treatment and the femoral head was stained. Compared with the control group, 24 patients had obvious reduction of hip pain and limpness. The total effective rate was 80%. No adverse reactions and complications occurred. Imaging examination found that the diseased femoral head collapse convex, sequestrum absorption, new bone formation. Conclusion The bone growth in infancy is exuberant. Superselective endovascular interventional treatment of ischemic necrosis of the femoral head epiphyseal is a method of small trauma, safety, fewer complications and definite curative effect. The joint function and the shape of the femoral head are different Improvement.