| Objective:The changes of Microcirculation between the normal femoral head and the regional of the necrotic femoral head were tested by DCE- MRI scanning quantitative analysis to explore the pathogenesis of the necrosis of the femoral head; Analyze the treatment of early avascular necrosis and the treatment mechanism of the core decompression combined pressure suction to provide a more effective clinical treatment and theoretical basis for the femoral head necrosis. Methods:1.Research objectChoose 15 cases patients, 12 men and 3 women, aged during 21 to 53 years old, with the early femoral head necrosis to be scanned by DCE-MRI. The average age was 36.1 years. There are 8 normal femoral heads and 22 necrotic femoral heads in 15 patients. According to association research circulation osseous(ARCO) classifying, 3, 4, 3, 6, 6 hips were in stage I A, IB, IC, IIB and IIC, respectively.2. Image processingAll patients performed DCE-MRI scan, and the original image would be sent to Siemens syngo workstation, using Tissue 4D software for data processing, and then the time-signal curve and the pseudo colour map of the different ROI are generated, and the Ktrans,Ve,Kep and i AUC of the different ROI are generated, too.3. surgical procedurePlace the patients in a supine position after lumbar anesthesia.C hoose the right into the needle point from the tuberosity along the direction of necrotic area center drilling into one of the needle which was 2.5 mm in diameter under C-arm X machine. See the needle in the right place under C-arm X machine, and use the hollow which was 6 mm in diameter to drill into the subchondral bone. Along the tunnel, put into a 5 mm diameter tube, seeing the tube in the right place under C-arm X machine. Fix suction tube, and connect the negative pressure aspirator, keep negative pressure(constant 100 mm Hg) attract one week.4. data collectionThe preoperative and postoperative 6 months Harris-scoring was got through outpatient care and telephone follow-up, and collecting the preoperative imaging data such as X-ray, MRI, DCE-MRI at the same time.5. The statistical methodsThe quantitative data processing used the SPSS 17.0 software, data as mean±standard deviation. The whole of femoral head necrosis were compared with the normal femoral head by one sample t-test.The comparison of blood vessel function parameter of the last area, avascular necrosis and border area were through single factor analysis of variance. The last area of femoral head necrosis, avascular area and border area were compared with the normal femoral head by one sample t-test. Harris-scorings of preoperative and postoperative 6 months were represented by paired t-test analysis if there was a statistically significant. The difference was statistically significant(P < 0.05). Results:1. Compared with the normal femoral head, the reinforcement signal of femoral head necrosis in the pseudo colour map is higher. The time-signal curve of the normal femoral head are horizontal, but the time-signal curve of the d ifferent area of femoral head necrosis is seeing an upward trend. It means that large changes have taken place in microcirculation after femoral head necrosis.2. The results of comparisions about the average of Ktrans, Kep, Ve and i AUC between the whole o f femoral head necrosis and the normal femoral head: the average of Ktrans, Ve and i AUC about the whole of femoral head necrosis is all greater than the average of Ktrans, Ve and i AUC about the normal femoral head. And the average of Kep about the whole of femoral head necrosis is less than the average of Kep about the normal femoral head. All the difference is statistically significant(P<0.05). It means that the permeability of blood vessel walls is increased and the change of microcirculation is mainly for posterior circulation stasis in the early stage femoral head necrosis. There is no obvious ischemia performance in the early stage femoral head necrosis.3. The results of multiple comparisions about the average of Ktrans among different areas of femoral head necrosis: the other area < the necrosis area <the border area. The difference is statistically significant of the multiple comparisions between the three areas(P<0.05). The results of multiple comparisions about the average of Kep among different areas of femoral head necrosis: the other area >the necrosis area >the border area. The difference between the other area and the necrosis areas is not statistically significant, the difference is statistically significant between the last areas multiple comparisions(P<0.05). The results of multiple comparisions about the average of Ve among different areas of femoral head necrosis: the other area < the necrosis area <the border area. The difference is statistically significant of the multiple comparisions between the three areas(P<0.05). The results of multiple comparisions about the average of i AUC among different areas of femoral head necrosis: the other area < the necrosis area <the border area. The difference is statistically significant of the multiple comparisions between the three areas(P<0.05). It means that the permeability of blood vessel walls is different in different areas of femoral head necrosis: the other area < the necrosis area <the border area. The posterior circulation stasis is different: the other area < the necrosis area <the border area.The multiple comparisons between the three areas and the blood perfusion are best in border area, and then is the necrosis area, the last is the other area.4. The results of comparisons about the average of Ktrans, Kep, Ve and i AUC between different areas of femoral head necrosis and the normal femoral head: the average of Ktrans of the normal femoral head is less than the average of Ktrans of the other area, border area and the necrosis area of femoral head necrosis; the average of Kep of the normal femoral head is greater than the means of Kep of the other area, border area and thenecrosis area of femoral head necrosis; the average of Ve of the normal femoral head is less than the average of Ve of the other area, border area and the necrosis area of femoral head necrosis; the average of i AUC of the normal femoral head is less than the average of i AUC of the other area, border area and the necrosis area of femoral head necrosis. The difference of the Ktrans and i AUC is not statistically significant between the normal femoral head and the other area. The difference of the i AUC is not statistically significant between the normal femoral head and the necrosis area. The difference is statistically significant of the multiple comparisions between the last area(P<0.05). It means that there is no obvious ischemia in femoral head necrosis, compared with the normal femoral head. It means that the permeability of blood vessel walls is increased and the changes of microcirculation are mainly for posterior circulation stasis in the early stage femoral head necrosis,too. 5. An average Harris hip score of 82.11 which is 6 months after surgery compared with the average preoperative Harris hip score of 62.47, P=0.000,the difference was statistically significant(P<0.05). Conclusions: 1. The quantitative analysis about the microcirculation changes between various areas of femoral head necrosis femoral head and the normal femoral head by DC E- magnetic resonance imaging(MRI) scan came to the conclusion:the pathophysiology mechanism of femoral head necrosis is that the hemal wall permeability is increased.Posterior circulation blood stasis, femoral head in high pressure, but the local microcirculation perfusion is not significantly reduced.2. Core decompression combined with negative pressure can effectively cure early stages of osteonecrosis of the femoral head. It is a new therapy for the treatment of early stages of osteonecrosis of the femoral head. |
PDF Full Text Request