本文選題：股骨頭缺血壞死 + 數(shù)字減影血管造影　； 參考：《廣州中醫(yī)藥大學》2012年碩士論文

【摘要】：目的： 研究股骨頭壞死病人的股骨頭供血血管的DSA表現(xiàn)和x線平片骨質(zhì)壞死硬化的相關(guān)性,從而明確是否能依靠簡單經(jīng)濟的x線平片來預(yù)判股骨頭壞死的發(fā)展和轉(zhuǎn)歸。 股骨頭缺血壞死是臨床多發(fā)病和常見病,目前治療上是一個世界性難題。多發(fā)生在中青年,如未經(jīng)有效治療,約80%在1-4年內(nèi)會進展到股骨頭塌陷而使關(guān)節(jié)功能損毀。多數(shù)患者不得不行人工關(guān)節(jié)置換,但就目前水平,中青年的人工關(guān)節(jié)置換術(shù)的長期療效仍難預(yù)測,因此,尋求保存患者自身關(guān)節(jié)的有效治療實有必要。股骨頭血液循環(huán)障礙是引起缺血壞死的核心問題。研究股骨頭頸部供血血管形態(tài),改善股骨頭血供是治療股骨頭缺血壞死的重要方法之一。股骨頭供血血管影像學研究包括CTA (CT血管造影)、CE-MRA(增強磁共振血管造影)、DSA(數(shù)字減影血管造影),其中最直觀最準確的方法就是數(shù)字減影血管造影(Digital subtraction angiography DSA),DSA技術(shù)可以在治療過程中用肉眼直接觀察到股骨頭缺血性壞死區(qū)周邊的血管影及染色,完整而清晰地了解缺血股骨頭的血供模式,被公認為血管成像的“金標準”。雖然其顯示血管精確度明顯優(yōu)于現(xiàn)行的其他檢查方法,但作為一種有創(chuàng)檢查,費用較高,操作較復雜,檢查風險也相對較大。目前,X線平片是股骨頭壞死最簡便最基礎(chǔ)的檢查方法,x線平片雖然敏感性較低,但具有一定的準確性,大部分病人可以通過X線平片檢查而得出診斷,而且平片也是股骨頭缺血壞死治療后隨訪復查最常用最經(jīng)濟的方法。所以,研究DSA股骨頭供血血管和股骨頭壞死X線平片中壞死硬化范圍的相關(guān)性,依靠x線平片對股骨頭壞死進行療效的評估、定期復查及臨床后續(xù)治療方案的制定都具有重要指導意義。 方法： l、分別運用方豆醫(yī)學影像系統(tǒng)自帶軟件和AUTOCAD(計算機輔助制圖軟件)來計算不規(guī)則圖形面積,分別測量行介入治療前兩周內(nèi)X平片上股骨頭壞死區(qū)和硬化區(qū)總面積和壞死區(qū)的面積,相減得出周圍骨密度增高(硬化帶)的面積,然后計算出硬化面積和壞死面積的比值,按照面積大小和面積比值高低順序分別編秩。 2、對符合標準病例的血管造影資料進行觀察、分析、記錄;主要指標包括：a觀察旋股內(nèi)動脈上支持帶,分出的干骺端上側(cè)動脈和骺外側(cè)動脈、下支持帶主干及主要分支干骺端下側(cè)動脈分支走形。 b旋股外動脈(上支)的走形c主要參照Trueta制定的標準,結(jié)合大量股骨頭供血血管解剖文獻及400余例的股骨頭供血血管DSA表現(xiàn),自擬改良標準進行評分,股骨頭供血血管基礎(chǔ)分為1分,旋股內(nèi)動脈共計3分,分別為上支持帶的干骺端上動脈和骺外側(cè)動脈和下支持帶動脈的干骺端下動脈有明顯穿支分別各1分。旋股外動脈上行支穿過支持帶動脈進入股骨頭部則計1分,然后將血管按照上述自擬標準對180髖進行評分(1至5分),按照供血血管由少到多的程度依次進行分級,按等級進行編秩。 3、對收集的180例符合納入標準的病例資料整理后,建立數(shù)據(jù)庫,采用秩相關(guān)(rank correlation),也稱等級相關(guān),計算兩者之間相關(guān)系數(shù),確定股骨頭供血血管與X線平片的硬化與壞死面積及其比值這些等級變量問相關(guān)聯(lián)的程度與方向。 結(jié)果： 經(jīng)Spearman等級相關(guān)分析得出,X線平片所反映的壞死和硬化帶面積比同供血血管主要分支數(shù)呈輕度負相關(guān)關(guān)系;壞死面積與供血血管分支數(shù)亦呈輕度負相關(guān)關(guān)系。 結(jié)論： 股骨頭壞死的DSA血管形態(tài)表現(xiàn),可以從主要方面反映股骨頭的血供狀態(tài)。股骨頭硬化帶為骨壞死-存活交界區(qū),在一定程度上反映骨壞死的修復過程。股骨頭的血供情況與壞死和硬化比之間呈負輕度負相關(guān)關(guān)系。DSA所反映的股骨頭血供與股骨頭壞死面積之間也是呈負輕度相關(guān)關(guān)系。x光平片在一定程度上,能大致反映股骨頭的血供狀態(tài)；可以依靠x光平片的壞死和硬化表現(xiàn)來大致判斷股骨頭壞死的發(fā)展和轉(zhuǎn)歸。
[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.
Method錛，

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