【作者】 侯昌龙；

【导师】 吕维富；

【作者基本信息】 安徽医科大学 ， 影像医学与核医学， 2005， 硕士

【摘要】 目的 通过对股骨头供血动脉栓塞建立股骨头缺血性坏死（avascular necrosis of femoral head,ANFH）（Ficat Ⅱ期以前）动物模型行经皮穿刺骨水泥注射,研究该法防治股骨头坏死关节面塌陷影像学及病理学变化,初步探讨该方法的安全性、可行性。材料与方法健康家猪20只,体重15～20 Kg左右,雌雄不拘。以真丝线段微绒毛行股骨头供血动脉栓塞,建立ANFH动物模型。制模后家猪自然饲养,青霉素预防性抗感染3～5天,每隔15天双侧髋关节MRI检查,评估股骨头坏死区大小、形态,行Ficat分期。TAE 1月时股骨头MRI呈长T1长T2信号,在T₂WI上低信号逐渐明显,脂肪抑制后显示更佳。将符合条件的家猪（Ficat Ⅱ期）随机分为2组,对照组（8只,16髋）和实验组（12只,24髋）。①对照组（A组,n=8）单纯行股骨头供血动脉栓塞术（TAE）,未行干预性治疗。观察股骨头自然塌陷情况。②经皮穿刺骨水泥注射组（B组,n=12）在DSA引导下,正侧位透视将COOK专用穿刺针自股骨上端外侧,经股骨颈穿刺至股骨头坏死区,注射调配好的磷酸钙骨水泥（CPC）,粉:液比为2:1。至骨水泥均匀致密填充骨坏死区停止注射。A组TAE后1月、2月及3月,B组注射CPC后1月、2月及3月,分别行双侧髋关节X平片、CT检查及股骨头组织病理学检查。比较两组间和B组干预前后不同时间段的影像学和病理学差异。两组均以临床症状结合影像学及病理学检查随访评估。结果经股骨头供血动脉栓塞研制动物模型,方法新颖、成功率高,可控性强;TAE术后股骨头坏死进行性加重,3个月内A组所有模型股骨头坏死塌陷,平均塌陷时间为1.5个月,症状为逐渐加重的跛行、瘫痪;影像学显示:股骨头缺血坏死经历Ficat Ⅰ～Ⅵ期动态改变;组织病理学示骨细胞逐渐坏死呈成片的红染灶,骨小梁由缺血水肿到完全断裂,高倍镜下单位面积的空缺骨陷窝数百分比（PBL）增更多还原

【Abstract】 Objective To study the technical way of animal model of ANFH with TAE (transcatheter arterial embolization) and to observe the effect with percutaneous injection of CPC(Calcium Phospate Cement) to prevent the articular surface from collapsing for ANFH (avascular necrosis of femoral head) in pigs.To explore a new method in the treatment of bone necrosis and collapse of the femoral head. Several technical points involved in TAE and CPC injection were dieussed. Materials and Methods 20 local ,healthy,crossbred pigs,without thinking about their sexualities,their branch arteries of the left femoral head were embolismed with the segments of silk .They were randomly divided into two groups after about 1 month assessed by MRI. Group A (n=8) called model contrast group, with only TAE and then surveried the avascular necrosis procedure of femoral head by imaging , pathologic and histologic examination.The other group,Group B (n=12), called percutaneous injection of Calcium Phospate Cement interventional treatment group,with percutaneous injection of Calcium Phospate Cement to ANFH at the stage Ficat II .We studied the changes of interesting femoral head in two groups by imaging such as roentgenography,CT and MRI. Pathologic and histologic examinations were also performanced in Group A and Group B .The bone tissues were dyed with HE and inspected with opical microscope.X-Ray films ,CT and MRI scan of femoral head were performed in special time. Results The animal models of ANFH in early stage were established by embolization of feeding artery. The method is very novel and its technical achievement ratio was high.The experimental controllability of TAE was easy and the main complications were更多还原