Transcatheter Hip Artery Perfusion Of Combination Of TCM And Western Medicine For Avascular Necrosis Of The Femoral Head: Clinical Study

Objective:To approach the effective treatment of avascular necrosis of femoral head(ANFH). To study the effect of transcatheter hip artery perfusion of combination of TCM and western medicine for ANFH and evavulate the factors on effect. Methods:According to the standard of diagnosis and selection of ANFH, 129 hips of 100 patients were enclosed into this study. By applying Seldinger's technique, a catheter was introduced via femoral artery into the contralateral common iliac artery and contrast medium was injected into it to know the blood supply of the hip .Then a suitable catheter was super-selectively introduced into medial femoral circumflex artery , lateral femoral circumflex artery, obturator artery , superior gluteal artery or inferior gluteal artery which supplyed blood to the femoral head and contrast medium was injected through the catheter . After angiography and photographs, medicines (including Ligustrazine 160~240mg , Urokinase 480,000 or 500,000 unit, low-molecular dextran 50~80ml and Papaverine 30mg )were injected slowly via the catheter. Angiography again after perfusion to study the changes of the local blood circulation . All patients were evaluated on clinic and imaging (including X-ray film , CT , MRI and angiography ) . By comparing the scores of pain , viability , activity of joints and walking distance, the clinical effects were observed and analysed . Results:Following intervention , the pain was markedly relieved and the viability was dramatically improved . The scores of pain and viability of each period after therapy were significantly greater than that before therapy (P<0.05) . The scores of activity of joints and walking distance of the stage 2 and stage 3 after therapy were significantly greater than that before therapy (P<0.05) . The long-term effect of stage land stage 2 was excellent. X-ray films of all patients followed up 1 months showed the lesions of the hips did not progress . Among the X-ray films of the hips followed up 6 months, 46.9% of the hips showed reparation change of the femoral head. Among the X-ray films of the hips followed up 1 years , 69.6% showed reparation change of the femoral head. X-ray films of 78.0% hips followed up more 2 years showed reparation change of the femoral head . X-ray films of 80.3% hips followed up more than 3 years showed reparation change of the femoral head . Amog the X-ray films of hips followed up more than 4 years , 78.6% showed reparation change of the femoral head . MRI imaging of51 hips showed that the areas of the necrotic bone decreased and the signal improved after the procedure . The angiography showed that not only the amount and diameter of the branchs of blood vessels but also the amount of communicating branches increased after treatment . It was demonstrated that patient|'s sex and pathogenis factors had nothing to do with the effect association with patient's age had something to do with the effect. Conclusion :Transcatheter hip artery perfusion of combination of TCM and western medicine is a very effective and safe treatment for avascular necrosis of the femoral head , especially for the patients of stage 1 to stage 2 . It can improve symptom and quality of life effectively. It can markedly relieve the pain and improve the viability dramatically . It is helpful for absorption of necrotic bone , formation and repairment of new bone matrix.