冲击波治疗不同面积股骨头坏死的疗效比较△

Comparison of extracorporeal shock wave therapy for ARCO stage II femoral head necrosis with different lesion areas

摘要:

[目的] 探讨冲击波对非创伤性股骨头坏死患者不同坏死面积的临床疗效。[方法] 回顾性分析 2017 年 1 月—2018 年 9 月经冲击波治疗 69 例(101 髋)ARCO II 期非创伤性股骨头坏死患者的临床资料，按治疗前坏死面积分为两组，≤30%组 35 例(52 髋)；＞30%组 34 例(49 髋)。比较两组临床与影像资料。[结果]所有病例在治疗部位均未出现严重不良反应。两组患者均随访 12~24 个月，平均(20.63±11.26)月。随时间推移，两组 VAS 和 Harris 评分，以及髋伸屈 ROM 和内-外旋 ROM 均呈曲线改变。治疗 6 个月时，≤30%组在 VAS 和 Harris 评分，以及髋伸屈 ROM 显著优于＞30%组(P＜0.05)，而两组间髋内-外旋 ROM 的差异无统计学意义(P＞0.05)。治疗 12 个月时，≤30%组 VAS 和 Harris 评分以及髋伸屈 ROM 和内-外旋 ROM 均显著优于＞30%组(P＜0.05)。末次随访时，≤30%组仅 VAS 评分显著优于＞30%组(P＜0.05)，而两组间 Harris 评分以及髋伸屈 ROM 和内-外旋 ROM 的差异已无统计学意义(P＞0.05)。影像方面，与治疗前相比，末次随访时两组的病变面积、股骨头塌陷程度和 Tonnis 退变分级均显著增加 (P＜0.05)。末次随访时，≤30%组的病变面积、股骨头塌陷程度仍显著小于＞30%组 (P＜0.05)， 但两组间 Tonnis 退变分级的差异仍无统计学意义(P＞0.05)。[结论]冲击波治疗非创伤性股骨头坏死在 12 个月内可明显缓解疼痛症状，改善髋关节功能，特别是对小面积坏死者效果更优。

Abstract:

[Objective] To investigate the clinical outcomes of extracorporeal shock wave therapy (ESWT) for ARCO stage II non-trau- matic femoral head necrosis with different lesion areas. [Methods] A retrospective study was done on 69 patients (101 hips) who received ESWT for ARCO stage II non-traumatic femoral head necrosis from January 2017 to September 2018. The patients were divided into two groups according to the area of necrosis measured on MRI before treatment, including 35 patients (52 hips) in the ≤30% group and 34 pa- tients (49 hips) in the ＞30% group. The clinical and imaging data of the two groups were compared. [Results] There were no serious adverse reactions happened in anyone of them during the therapy. Patients in both groups were followed up for 12-24 months, with an average of (20.63±11.26) months. The VAS and Harris scores, as well as hip flexion-extension range of motion(ROM) and internal-external rotation ROM variated in curve manner in both groups over time. At 6 months after treatment, the ≤30% group proved significantly superior to the ＞ 30% group in terms of VAS and Harris scores and hip flexion-extension ROM (P＜0.05) , whereas there was no statistically significant dif- ference between the two groups in term of internal- external rotation ROM (P＞0.05). At 12 months after treatment, the ≤30% group was sig- nificantly superior to the ＞30% group in terms of VAS and Harris scores, as well as hip flexion-extension ROM and internal-external rota- tion ROM (P＜0.05) . However, the ≤30% group was only significantly better than the ＞30% group in VAS score (P＜0.05) , whereas the dif- ferences in Harris score, hip flexion-extension ROM and internal-external ROM between the two groups became not statistically significant at the latest follow up (P＞0.05) . Radiographically, the lesion area, the degree of femoral head collapse, and the Tonnis scales of hip degen- eration significantly worsened in both groups at the latest follow-up compared with before treatment (P＜0.05) . At the last follow-up, the le- sion area and femoral head collapse in the ≤30% group remained significantly smaller than that of the ＞30% group (P＜0.05) , but there was no significant difference in the extent of Tonnis degeneration grades between the two groups (P＞0.05) . [Conclusion] ESWT does consider-ably relieve pain and improve hip function within 12 months, especially for those with smaller lesion areas of ARCO stage II non-traumatic femoral head necrosis.