髓芯减压联合负压吸引术治疗早期股骨头坏死的临床研究

发布时间：2018-04-10 23:33

  本文选题：负压吸引 + 早期股骨头坏死　； 参考：《河北北方学院》2016年硕士论文

【摘要】：通过动态增强MRI(DCE-MRI)扫描定量分析髓芯减压联合负压吸引术治疗早期股骨头坏死术前术后各区域间的微循环变化,评价其疗效及分析其治疗机理,为临床治疗早期股骨头坏死提供一种更为有效的方法。对纳入的早期股骨头坏死患者行髓芯减压联合负压吸引术,于术后1、3、6、12个月对患者进行随访,行髋关节X线检查,并记录其Harris髋关节评分和VAS评分,以判定术后髋关节功能的改善情况;术后1、3、6个月对患者行髋关节DCE-MRI扫描,以检测股骨头相关血管功能定量参数Ktrans、Kep、Ve、iAUC值,以定量分析股骨头坏死各区域术前术后微循环的变化。术后的各回访时间点经X线及DCE-MRI扫描未见坏死股骨头发生塌陷或坏死区明显扩大的情况发生。除VAS评分在术前与术后1月相比较,差异(P0.05)无统计学意义外,其余术后各回访时间点的Harris及VAS评分与术前相应评分相比较,差异(P0.05)均有显著统计学意义。在ARCOⅠ期组坏死区参数Kep术后3、6个月与术前相比较,差异(P0.05)有统计学意义;坏死区iAUC术后3个月与术前相比较,差异(P0.05)有统计学意义;在ARCOⅡ期组坏死区参数Ve术前与术后1个月相比较,差异(P0.05)有统计学意义。ARCOⅠ、Ⅱ期这4个参数在其他术前与术后各区各时间点相比较,差异(P0.05)无统计学意义。本研究初步表明髓芯减压联合负压吸引术是一种新的治疗早期股骨头坏死的保头治疗方法,并表明该新的手术方法对治疗早期股骨头坏死的效果,在短期内可有效地改善髋关节功能,减轻疼痛症状,并具有延缓坏死股骨头的塌陷的作用。初步表明该新的手术方法对治疗早期股骨头坏死,对ARCOⅠ期坏死股骨头的微循环瘀滞问题,得到一定程度的改善,但对ARCOⅡ期坏死股骨头的微循环改善情况不明显,并可促进坏死区和交界区毛细血管生成。受限于实验研究的样本数,该新的手术方法对治疗早期股骨头坏死的临床效果及改善微循环瘀滞的情况,需要进一步大样本、长期随访观察及病理实验后才可得出更为确切的结论。
[Abstract]:Dynamic enhanced MRI DCE-MRI scanning was used to quantitatively analyze the changes of microcirculation between different regions before and after treatment of early femoral head necrosis by core decompression combined with negative pressure suction, and to evaluate its curative effect and analyze its therapeutic mechanism.To provide a more effective method for the treatment of early femoral head necrosis.The patients with early femoral head necrosis were treated with core decompression combined with negative pressure suction. The patients were followed up for 12 months with Harris hip score and VAS score.In order to evaluate the improvement of hip function after operation, DCE-MRI scanning was performed on the hip joint at 1 and 6 months after operation to detect the quantitative parameters of the femoral head related vascular function (KtransN), and to quantitatively analyze the changes of microcirculation in various areas of femoral head necrosis before and after operation.No collapse of the femoral head or obvious expansion of the necrotic area was observed on X-ray and DCE-MRI scans.There was no significant difference in VAS score between preoperative and postoperative month (P 0.05), but there was significant difference in Harris and VAS scores between preoperative and postoperative time points (P 0.05).There were significant differences in the parameters of necrotic zone between 3 months and 6 months after operation in ARCO stage 鈪，

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