儿童股骨头骨骺缺血坏死介入治疗
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摘要
目的研究儿童股骨头骨骺缺血坏死(Perthe's病)药物灌注治疗前后供血动脉造影的改善情况以及与不同年龄段的占比关系,达到最优化治疗效果。方法对164例Perthe's病患者行超选择骨骺供血动脉造影及药物灌注治疗,对比灌注前后供血动脉数目及染色面积,总结内骺动脉及外骺动脉占比与不同年龄段的相关性,所有病例随访6个月～1年。结果 164例Perthe's病药物灌注前后动脉造影及不同年龄段与供血动脉的占比分析研究表明:(1)治疗后血管开通数目及染色面积占比较前增多,其中,内骺动脉(146例)血管数目由1～2条开通至1～3条,染色面积占比由26. 10%增加至41. 43%,差异有统计学意义(P <0. 05)。外骺动脉(50例)血管数目由0～1条开通至1～2条,染色面积占比由22. 9%增加至42. 86%,差异有统计学意义(P <0. 05)。(2)灌注前供血动脉与年龄的相关性:(1)≤3岁(52例):占比50%以上内骺动脉(32/52,61. 5%)多于外骺动脉(4/52,7. 7%),差异有统计学意义(P <0. 05);(2)4～8岁(94例):占比50%以上内骺动脉(30/94,31. 9%)多于外骺动脉(2/94,2. 1%),差异有统计学意义(P <0. 05);(3)> 9岁(18例):占比50%以上内骺动脉(8/18,44. 4%)多于外骺动脉(3/18,16. 7%),差异有统计学意义(P <0. 05)。结论 Perthe's病通过药物灌注治疗后血管开通数目及染色面积占比较前明显增多,不同年龄段供血动脉及占比不同,应根据其年龄及占比采取不同的动脉灌注治疗,从而达到更优化的治疗效果。
Objective To study the improvement of arteriography of ischemic necrosis in childern with femoral head epiphysis( Perthe's disease) before and after drug infusion,and the proportion of different ages,to achieve the optimal therapeutic effect. Methods 164 patients with Perthe's disease were treated with superselective epiphyseal arteriography and drug infusion. Comparison of the number of blood supply arteries and staining area before and after perfusion,and the correlation between the proportion of epiphyseal and exoepiphyseal arteries and different ages was summarized. All cases were followed up for 6 months to 1 year. Results Arteriography of 164 cases of Perthe's disease before and after drug infusion and the proportion of different age and blood supply arteries were analyzed and showed that: 1. The number of vascular opening and staining area increased after treatment,including the number of epiphyseal artery( 146 cases) was opened from1-2 to 1-3,staining area from 26. 10% increased to 41. 43%,P < 0. 05. The difference was statistically significant. The number of exoepiphyseal arteries( 50 cases) was opened from 0-1 to 1-2,and the proportion of staining area was increased from 22. 9% to 42. 86%,P < 0. 05. The difference was statistically significant. 2. the correlation between the blood supply artery and age( before perfusion) :( 1) ≤3 years( 52 cases) : epiphyseal arteries accounted for > 50%( 32/52,61. 5%) more than exoepiphyseal arteries( 4/52,7. 7%),P < 0. 05,The difference was statistically significant;( 2) 4-8 years( 94 cases) : Epiphyseal arteries accounted for > 50%( 30/94,31. 9%) more than exoepiphyseal arteries( 2/94,2.1%),P < 0. 05. The difference was statistically significant.( 3) > 9 years( 18 cases) : Epiphyseal arteries accounted for >50%( 8/18,44. 4%) more than exoepiphyseal arteries( 3/18,16. 7%),P < 0. 05. The difference was statistically significant. Conclusion The number of vascular opening and staining area of Perthe's disease after drug perfusion increased significantly before the comparison. Different age should be given different arterial perfusion should be given different according to their age and proportion,so as to achieve the optimal therapeuticeffect.
Objective To study the improvement of arteriography of ischemic necrosis in childern with femoral head epiphysis( Perthe's disease) before and after drug infusion,and the proportion of different ages,to achieve the optimal therapeutic effect. Methods 164 patients with Perthe's disease were treated with superselective epiphyseal arteriography and drug infusion. Comparison of the number of blood supply arteries and staining area before and after perfusion,and the correlation between the proportion of epiphyseal and exoepiphyseal arteries and different ages was summarized. All cases were followed up for 6 months to 1 year. Results Arteriography of 164 cases of Perthe's disease before and after drug infusion and the proportion of different age and blood supply arteries were analyzed and showed that: 1. The number of vascular opening and staining area increased after treatment,including the number of epiphyseal artery( 146 cases) was opened from1-2 to 1-3,staining area from 26. 10% increased to 41. 43%,P < 0. 05. The difference was statistically significant. The number of exoepiphyseal arteries( 50 cases) was opened from 0-1 to 1-2,and the proportion of staining area was increased from 22. 9% to 42. 86%,P < 0. 05. The difference was statistically significant. 2. the correlation between the blood supply artery and age( before perfusion) :( 1) ≤3 years( 52 cases) : epiphyseal arteries accounted for > 50%( 32/52,61. 5%) more than exoepiphyseal arteries( 4/52,7. 7%),P < 0. 05,The difference was statistically significant;( 2) 4-8 years( 94 cases) : Epiphyseal arteries accounted for > 50%( 30/94,31. 9%) more than exoepiphyseal arteries( 2/94,2.1%),P < 0. 05. The difference was statistically significant.( 3) > 9 years( 18 cases) : Epiphyseal arteries accounted for >50%( 8/18,44. 4%) more than exoepiphyseal arteries( 3/18,16. 7%),P < 0. 05. The difference was statistically significant. Conclusion The number of vascular opening and staining area of Perthe's disease after drug perfusion increased significantly before the comparison. Different age should be given different arterial perfusion should be given different according to their age and proportion,so as to achieve the optimal therapeuticeffect.
引文
1 Kamath AF,Mc Graw MH,Israelite CL. Surgical management of osteonecrosis of the femoral head in patients with sickle cell disease[J]. World J Orthop,2015,6:776-782.
2 Zibis AH,Karantanas AH,Roidis NT,et al. The role of MR imaging in staging femoral head osteonecrosis[J]. Eur J Radiol. 2007,63:3-9.
3 单洪,姜波.临床血管解剖学[M],广州:广东世界图书出版公司,2001,296-301.
4 辛顺宝,齐先龙,郑宁.小儿股骨头骨骺缺血坏死的MRI表现及临床特点分析[J].医学影像学杂志,2015,25:1066-1068.
5 Kim HK. Legg-Calve-Perthes disease:etiology,pathogenesis,and biology[J]. J Pediatr Orthop,2011,31:S141-146.
6 Nelitz M,Lippacher S,Krauspe R,et al. Perthes disease:current principles of diagnosis and treatment[J]. Dtsch Arztebl Int,2009,106:517-523.
7 吉士俊.股骨头骨骺炎(Legg-Perthes)病研究治疗进展[J].临床小儿外科杂志,2004,3:191-194.
8 林永,周青.非创伤性股骨头缺血性坏死介入治疗的效果评价[J].中国介入放射学,2008,2:263-264.
9 于宁,陈卫衡.中药多途径用药治疗股骨头骨骺坏死的回归性研究[J].贵阳中医学院学报,2009,31:73-75.
10 刘洪智,王智耀,奚向宇,等.儿童股骨头骨骺坏死临床回顾性研究[J].中国矫形外科杂志,2013,21:1513-1518.
11 侯赛榕,介入治疗股骨头缺血性坏死的应用解剖学研究[D].广州:南方医科大学,2012.
12 刘新献,黄穗,刘帆,等.超选择血管内介入治疗儿童股骨头骨骺缺血性坏死的疗效分析[J].临床放射学杂志,2012,31:1160-1163.
2 Zibis AH,Karantanas AH,Roidis NT,et al. The role of MR imaging in staging femoral head osteonecrosis[J]. Eur J Radiol. 2007,63:3-9.
3 单洪,姜波.临床血管解剖学[M],广州:广东世界图书出版公司,2001,296-301.
4 辛顺宝,齐先龙,郑宁.小儿股骨头骨骺缺血坏死的MRI表现及临床特点分析[J].医学影像学杂志,2015,25:1066-1068.
5 Kim HK. Legg-Calve-Perthes disease:etiology,pathogenesis,and biology[J]. J Pediatr Orthop,2011,31:S141-146.
6 Nelitz M,Lippacher S,Krauspe R,et al. Perthes disease:current principles of diagnosis and treatment[J]. Dtsch Arztebl Int,2009,106:517-523.
7 吉士俊.股骨头骨骺炎(Legg-Perthes)病研究治疗进展[J].临床小儿外科杂志,2004,3:191-194.
8 林永,周青.非创伤性股骨头缺血性坏死介入治疗的效果评价[J].中国介入放射学,2008,2:263-264.
9 于宁,陈卫衡.中药多途径用药治疗股骨头骨骺坏死的回归性研究[J].贵阳中医学院学报,2009,31:73-75.
10 刘洪智,王智耀,奚向宇,等.儿童股骨头骨骺坏死临床回顾性研究[J].中国矫形外科杂志,2013,21:1513-1518.
11 侯赛榕,介入治疗股骨头缺血性坏死的应用解剖学研究[D].广州:南方医科大学,2012.
12 刘新献,黄穗,刘帆,等.超选择血管内介入治疗儿童股骨头骨骺缺血性坏死的疗效分析[J].临床放射学杂志,2012,31:1160-1163.