| Objective: To investigate change of blood supply of necrotic femoral head(ONFH)using digital subtraction angiography(DSA).Methods: DSA was used to evaluate the blood per-fusion of ONFH in 81 patients(81hips)between 1/1/2012 and 1/1/2017.Sixty males and 21 females were included,with a mean age of 34.6 years old(range,20-68 years).The necrotic hips were grouped according Association Research Circulation Osseous(ARCO)staging classification.A consensus definition was reached,ultimately classifying 31 hips as ARCO ?,30 hips as ARCO ? and 20 hips as ARCO ?.We then picked the most “effective” film from the femoral artery(FA)and medial circumflex femoral artery(MCFA)from each patient and determined whether each vessel was intact,without blurring or interruption.Five parameters were assessed to evaluate the intraosseous blood supply of the necrotic femoral head.On an “effective” film of the FA,the diameters of the deep femoral artery(DFA),MCFA and lateral circumflex femoral artery(LCFA)within 2 cm were measured.The relative widths of the MCFA and LCFA were evaluated using the following ratios:MCFA/DFA,the ratio of blood vessel diameter between MCFA and DFA.LCFA/DFA,the ratio of blood vessel diameter between LCFA and DFA.On“effective” film of MCFA.The ratio between MCFA extending length and width of the femoral neck(A).?t represents the relative length of the MCFA and indirectly measures the blood supply to the femoral head.a,the number of vessels that reached or exceeded line ?(a horizontal line at the upper junction of the femoral head and neck.The superior posterior retinacular arteries above this line,which enter the femoral head at the junction of the femoral head and neck,supply blood to the lateral 60%-75% of the femoral head.b,the number of vessels that reached or exceeded line ?(connecting the upper and lower junctions of the femoral head and neck.The inferior posterior retinacular arteries arise from the MCFA,which courses through the femoral head along the lower edge of the femoral head cartilage,and supplies 25%–50% of the area above this line.Data were analyzed statistically by SPSS 23.Results:1.The ratio of the MCFA/DFA and LCFA/DFA reflects the relative width of the MCFA and the LCFA,respectively.Calculating this ratio can reduce the error caused by individual differences.The mean MCFA/DFA of patients with stage ?,? and ? disease was 0.41±0.08,0.41±0.12 and 0.39±0.11,respectively.The mean LCFA/DFA of patients with stage ?,? and ? was 0.64±0.12,0.67±0.12 and 0.68±0.13,respectively.The mean ratio of A in patients with stage ?,? and ? disease was 0.85,0.80 and 0.60,respectively.The mean ratio of a in patients with stage ?,? and ? was 1.84,1.07 and0.30 and b were 1.90,1.13 and 1.00,respectively.2 The MCFA/DFA(p=0.841>0.05)and LCFA/DFA(p=0.543>0.05)were not statistically significant between patients with ARCO stage ? to ? disease,as calculated by one-way ANOVA.However,A(p=0.040<0.05),b(p=0.013<0.05)and especially a(p=0.000<0.01)with ARCO stage ? to ? were found to be statistically significant by the rank-sum test3 The A,a and b have a negative relationship with ARCO stage.Conclusions: This preliminary study shows that the relative length of the MCFA and number of vessels above line ? and line ? are related to the severity of ONFH at ARCO stage ? to ?.There was not statistically significant between the width of MCFA and LCFA and the severity of ONFH.DSA can be used as an important method to evaluate blood supply and predict the fate of pre-collapsed ONFH. |
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