股骨头坏死DSA血管形态和平片骨质硬化的相关性

发布时间：2018-04-11 11:20

  本文选题：股骨头缺血坏死 + 数字减影血管造影　； 参考：《广州中医药大学》2012年硕士论文

【摘要】：目的： 研究股骨头坏死病人的股骨头供血血管的DSA表现和x线平片骨质坏死硬化的相关性,从而明确是否能依靠简单经济的x线平片来预判股骨头坏死的发展和转归。 股骨头缺血坏死是临床多发病和常见病,目前治疗上是一个世界性难题。多发生在中青年,如未经有效治疗,约80%在1-4年内会进展到股骨头塌陷而使关节功能损毁。多数患者不得不行人工关节置换,但就目前水平,中青年的人工关节置换术的长期疗效仍难预测,因此,寻求保存患者自身关节的有效治疗实有必要。股骨头血液循环障碍是引起缺血坏死的核心问题。研究股骨头颈部供血血管形态,改善股骨头血供是治疗股骨头缺血坏死的重要方法之一。股骨头供血血管影像学研究包括CTA (CT血管造影)、CE-MRA(增强磁共振血管造影)、DSA(数字减影血管造影),其中最直观最准确的方法就是数字减影血管造影(Digital subtraction angiography DSA),DSA技术可以在治疗过程中用肉眼直接观察到股骨头缺血性坏死区周边的血管影及染色,完整而清晰地了解缺血股骨头的血供模式,被公认为血管成像的“金标准”。虽然其显示血管精确度明显优于现行的其他检查方法,但作为一种有创检查,费用较高,操作较复杂,检查风险也相对较大。目前,X线平片是股骨头坏死最简便最基础的检查方法,x线平片虽然敏感性较低,但具有一定的准确性,大部分病人可以通过X线平片检查而得出诊断,而且平片也是股骨头缺血坏死治疗后随访复查最常用最经济的方法。所以,研究DSA股骨头供血血管和股骨头坏死X线平片中坏死硬化范围的相关性,依靠x线平片对股骨头坏死进行疗效的评估、定期复查及临床后续治疗方案的制定都具有重要指导意义。 方法： l、分别运用方豆医学影像系统自带软件和AUTOCAD(计算机辅助制图软件)来计算不规则图形面积,分别测量行介入治疗前两周内X平片上股骨头坏死区和硬化区总面积和坏死区的面积,相减得出周围骨密度增高(硬化带)的面积,然后计算出硬化面积和坏死面积的比值,按照面积大小和面积比值高低顺序分别编秩。 2、对符合标准病例的血管造影资料进行观察、分析、记录;主要指标包括：a观察旋股内动脉上支持带,分出的干骺端上侧动脉和骺外侧动脉、下支持带主干及主要分支干骺端下侧动脉分支走形。 b旋股外动脉(上支)的走形c主要参照Trueta制定的标准,结合大量股骨头供血血管解剖文献及400余例的股骨头供血血管DSA表现,自拟改良标准进行评分,股骨头供血血管基础分为1分,旋股内动脉共计3分,分别为上支持带的干骺端上动脉和骺外侧动脉和下支持带动脉的干骺端下动脉有明显穿支分别各1分。旋股外动脉上行支穿过支持带动脉进入股骨头部则计1分,然后将血管按照上述自拟标准对180髋进行评分(1至5分),按照供血血管由少到多的程度依次进行分级,按等级进行编秩。 3、对收集的180例符合纳入标准的病例资料整理后,建立数据库,采用秩相关(rank correlation),也称等级相关,计算两者之间相关系数,确定股骨头供血血管与X线平片的硬化与坏死面积及其比值这些等级变量问相关联的程度与方向。 结果： 经Spearman等级相关分析得出,X线平片所反映的坏死和硬化带面积比同供血血管主要分支数呈轻度负相关关系;坏死面积与供血血管分支数亦呈轻度负相关关系。 结论： 股骨头坏死的DSA血管形态表现,可以从主要方面反映股骨头的血供状态。股骨头硬化带为骨坏死-存活交界区,在一定程度上反映骨坏死的修复过程。股骨头的血供情况与坏死和硬化比之间呈负轻度负相关关系。DSA所反映的股骨头血供与股骨头坏死面积之间也是呈负轻度相关关系。x光平片在一定程度上,能大致反映股骨头的血供状态；可以依靠x光平片的坏死和硬化表现来大致判断股骨头坏死的发展和转归。
[Abstract]:Objective:
Objective to study the correlation between DSA findings of femoral head blood supply vessels and X-ray slice osteonecrosis and sclerosis in patients with osteonecrosis, so as to determine whether we can predict the development and outcome of osteonecrosis of the femoral head based on simple and economical X-ray plain film.
Avascular necrosis of the femoral head is a clinical common disease, the treatment is a difficult problem in the world. Occurs in youth, without effective treatment, about 80% will progress to the collapse of the femoral head and the function of joint damage in 1-4 years. Most of the patients had to undergo hip replacement, but in the current level and the long-term efficacy of artificial joint replacement in youth is still difficult to predict, therefore, it is necessary to seek the effective treatment of patients with preserved their joints. The femoral head blood circulation disorder is caused by the core problem. Study on ischemic necrosis of femoral head and neck vascular morphology, improve the blood supply of the femoral head is one of the important methods for the treatment of femoral head ischemia necrosis of the femoral head. Blood vessel imaging studies including CTA (CT angiography), CE-MRA (enhanced magnetic resonance angiography), DSA (DSA), one of the most intuitive method is the most accurate digital subtraction Angiography (Digital subtraction angiography DSA), DSA technology can be directly observed and staining of peripheral vascular femoral avascular necrosis of the eye in the treatment process, complete and clear understanding of the ischemic femoral head blood supply pattern, vascular imaging is recognized as the "gold standard". Although the accuracy is better than that of blood vessels the other inspection methods, but as an invasive examination, high cost, complicated operation, check the risk is relatively large. At present, the X-ray examination method of femoral head necrosis is the most basic, X-ray although sensitivity is low, but has a certain accuracy, most patients can be diagnosed by X-ray, and X-ray is avascular necrosis of the femoral head after treatment follow-up the most economic method. Therefore, the research of DSA femoral head blood vessel and necrosis of femoral head The correlation between necrosis and sclerotherapy in X-ray plain film depends on X-ray plain film for evaluating the curative effect of femoral head necrosis. Regular reexamination and formulation of clinical follow-up treatment plan are of great guiding significance.
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