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目的探讨MRI随访在经导管动脉灌注(TAI)治疗非创伤性股骨头缺血性坏死(ANFH)疗效评估中的价值。方法对22例(30髋)经临床和影像学检查确诊的非创伤性ANFH患者采用TAI治疗,并比较治疗前后临床症状、髋关节功能及MRI影像改变。随访观察9~36个月。按ARCO分期,0期1髋;Ⅰ期6髋;Ⅱ期20髋;Ⅲa期3髋。结果 TAI术后,0期+Ⅰ期患者髋关节功能评分由术前平均(82.7±2.48)分增至术后平均(99.98±3.45)分;Ⅱ期患者髋关节功能评分由术前平均(76.9±3.23)分增至术后平均(95.07±3.68)分;Ⅲa期患者髋关节功能评分由术前平均(69.8±1.22)分增至术后平均(90.09±3.17)分。差异均有显著性统计学意义(P<0.05)。MRI随访发现19髋(63.3%)有不同程度好转,股骨头坏死区病灶稳定,见增生、硬化及囊变缩小,骨髓水肿范围变小,髋关节积液减少;2髋(6.7%)病变基本保持不变;9髋(30%)病变加重,表现为骨髓水肿范围增大、髋关节积液增多,但在继续随访中病变好转。结论非创伤性ANFH患者TAI术后MRI随访有一定的价值,但需结合患者的临床及其他影像资料才是科学的随访措施。
Objective To investigate the value of MRI follow-up in assessing the efficacy of transcatheter arterial infusion (TAI) in the treatment of non-traumatic avascular necrosis of the femoral head (ANFH). Methods Twenty-two patients (30 hips) with non-invasive ANFH diagnosed by clinical and imaging examination were treated with TAI. The clinical symptoms, hip joint function and MRI imaging were compared before and after treatment. Follow-up observation of 9 to 36 months. According to ARCO staging, stage 0 hips; stage Ⅰ 6 hips; stage Ⅱ 20 hips; stage Ⅲ a 3 hips. Results After TAI, the hip joint function score of patients in stage 0 and stage Ⅰ was increased from preoperatively (82.7 ± 2.48) to postoperative average (99.98 ± 3.45) points. The hip function score of patients in stage Ⅱ was improved from preoperative ± 3.23) points to mean postoperative (95.07 ± 3.68) points. The hip function score of patients in stage Ⅲa increased from preoperative average (69.8 ± 1.22) to postoperative average (90.09 ± 3.17) points. The differences were statistically significant (P <0.05). Follow-up of MRI showed that 19 hips (63.3%) improved to varying degrees, and the lesions in the necrosis of femoral head were stable. See hyperplasia, sclerosis and cystic degeneration, the range of bone marrow edema became smaller and the effusion of hip joint reduced. Remained unchanged; 9 hips (30%) lesions aggravated, showed an increase in the range of bone marrow edema, increased hip fluid, but in the follow-up of lesions improved. Conclusion The follow-up of post-TAI MRI in patients with non-invasive ANFH is of certain value. However, it is necessary to combine the clinical and other imaging data of the patients to be a scientific follow-up.