Clinical Studies On Interventional Therapy For Adult Avascular Necrosis Of Fermoral Head

Purpose: To evaluate the near-future clinical efficacy of Shuxuening,Urokinase, anisodamine, low-molecular dextran and Papaverine in theInterventional therapy for adult avascular necrosis of femoral head, andevaluate the factors on effect.Methods: A total of twenty-nine patients(40hips) with adult avascularnecrosis of the femoral head according to the standard of diagnosisi andselection received the interventional therapy in department of orthopedics,zhangzhou hospital of TCM, Fujian province from April 2003～October 2006 wereselect. The cilinical efficacy and imaging(including X-ray and DSA) wereanalyzed by Self before-after study. The preoperative score of Harris wascollected by questionnaire and clinical examination. After angiography andphotographys, medicines (Shuxuening 20ml, Urokinase 300000 unit, anisodamine20mg, low-molecular dextran 200ml and Papaverine 30mg) were injected the hipby using Seldinger' s technique. The hip was injected the second time after 10days. Study the changes of the local blood circulation of the hip before the twoinjections. The data on the interventional therapy outcomes and the postoperativescore of Harris were collected by using clinical follow-up. By statisticsanalysing, we compare the cilinical effecacy of diffierence group of aging,BMI(body mass index) by more point of view and more levels to conclude thecilinical effecacy and the factors on effect in the Interventional therapy foradult avascular necrosis of femoral head.Result:1. Twenty-nine patients(4Ohips) were followed up. After six monthsfollowed up, the score of Harris was improved from 74.84±5.68 to 84.53±7.41. after two times Interventional therapy and the excellent/good rates in thetotal cases were changed from 30% to 72.5%. There are no significant differenceof the clinical efficacy duing the two groups of 6 months following up and 12months following up (p＜0.05) by T test. 2. Among the X-ray films of all patientsfollowed up 6 months, 9 hips (22.5%) showed reparation change of the femoralhead. Among the X-ray films of all patients followed up 12 months, 15 hips (37.5%)showed reparation change of the femoral head. The amount of blood vessels havesignificant difference before the two times perfusions(p＜0.05) by T test. 3.Prognostic factor:The prognosi of low-age group (between the age of 18～40)is betrter than the high-age group ((between the age of 41～60, womenunder 55). There are no significant difference of clinical efficacy betweenthe non-traumatic avascular necrosis and the traumatic avascular necrosis ofthe femoral head; The prognosi of the avascular necrosis of femoral heads withdifferent BMI(body mass index) had nothing to do with the near-future clinicalefficacy.Conclusion:1. Interventional therapy with Shuxuening injection, Urokinase,anisodamine, low-molecular dextran and Papaverine can improve the near-futureclinical efficacy of adult avascular necrosis of femoral head and the bloodsupply of the femoral head which is an effective and reliable method in thetreatment of adult avascular necrosis of femoral head. It can remit pain anddelay the time of artificial replacement. The long-term clinical result need moreclinical observation. 2. There are close relation between the prognosi of theInterventional therapy for adult avascular necrosis of femoral head andage. While the causes and BMI have no significant effect on the near-futureclinical efficacy. Therefore, patients with avascular necrosis of the femoralhead in earlier peioriod should accept the interventional therapy when he isyong.