摘要
目的观察体外高能震波治疗股骨头缺血性坏死的近期疗效。方法自2004年10月～2005年10月，采用体外高能震波治疗股骨头缺血性坏死30例40髋。根据X线片及MRI进行股骨头坏死的ARCO分期：Ⅰ期8髋，Ⅱ期17髋，Ⅲ期15髋。采用X线透视结合MRI影像对坏死病灶进行定位，每侧股骨头选择4个震波治疗点，震波治疗参数：电压28kV、脉冲频率4Hz、每点冲击数1000次。震波治疗后2～3个月内患肢不负重。采用疼痛VAS评分、Harris髋关节功能评分、X线及MRI评估疗效。结果12例18髋治疗后局部出现瘀斑、皮下出血和轻微肿胀，未发现其它并发症。所有患者平均随访11．2个月，自觉症状改善33髋，无变化7髋。疼痛VAS评分治疗前平均（6．7±2．0）分，治疗后平均（2．5±2．3）分，差异有统计学意义（P〈0．05）。Harris评分治疗前平均（64．3±14．7）分，治疗后平均（81．9±9．3）分，差异有统计学意义（P〈0．05），去除疼痛得分后Harris评分治疗前后差异无统计学意义（P〉0．05）。随访期内MRI影像学改善15髋，无变化20髋，病变进展5髋，有2例2髋接受全髋关节置换术。结论体外高能震波治疗早中期股骨头缺血性坏死的近期疗效明显，主要表现为疼痛症状减轻和功能改善，具有操作简便和无创等优点，是一种较好的替代治疗方法。
Objective To observe the early effects of high energy extracorporeal shock wave on osteonecrosis of the femoral head. Methods Between October 2004 to October 2005, 30 patients with 40 osteonecrotic femoral heads, 12 females and 18 males, were treated with high-energy extracorporeal shock wave. The causes included trauma （8）, steroid usage （13）, alcohol （4） and idiopathy （5）. According to Association Research Circulation Osseous（ARCO） classification, 8 hips were of stage Ⅰ, 17 hips of stage Ⅱ and 15 hips of stage Ⅲ. Treatment was performed under spinal anesthesia. The necrotic lesions were localized with C-arm X-ray and/or the MRI. Four focal treatment points were selected in each patient. The parameters of shock wave were 28 kV, 4 Hz and 1000 pulses for each point. Non-weight bearing was necessary for 2 to 3 months after treatment. Follow-up examinations were scheduled at 6, 12, 24 weeks and then once a year. The evaluations included VAS pain score, Harris score, the X-ray and MRI. Results Except local petechial hemorrhage or local swelling in 18 hips of 12 patients after therapy, there were no other complications. The mean follow-up was 11.2 months （6 to 18 months）. The patients stated symptom improvement in 33 hips and no change in 7 hips. The mean pain score significantly improved from 6.7 ± 2.0 before treatment to 2. 5 ± 2.3 after treatment （ P 〈 0. 05） . The mean Harris score significantly improved from 64.3 ± 14. 7 before treatment to 81.9 ±9. 3 at the latest follow-up（ P 〈 0. 05）, but there was no significant difference if the pain score was excluded from Harris score. The follow-ups revealed the X-ray or MRI improvement in 15 hips, no change in 20 hips and deterioration in 5 hips, 2 of which had to receive total hip replacement. Conclusions The high-energy shock wave appear to be effective at the early and mid stages of osteonecrosis. It can reduce pain and improve the hip function. Being non-invasive and safe, it is a good alternative therapy for early osteon
出处
《中华创伤骨科杂志》
CAS
CSCD
2007年第5期415-418,共4页
Chinese Journal of Orthopaedic Trauma
关键词
高能量震波
股骨头坏死
物理疗法
High-energy shock wave
Femur head necrosis
Physical therapy
