体外冲击波疗法联合钻孔减压术治疗战士训练后股骨头缺血性坏死的效果观察  

Therapeutic effects of extracorporeal shock waves combined with drilling decompression for the treatment of femoral head ischemic necrosis due to training in servicemen

作　　者：翟磊[1] 邢更彦[1] 姜川[1] 李冰[1] 赵哲[1] 王旭明[1] 

机构地区：[1]武警总医院关节四肢外科,北京100039

出　　处：《解放军医学杂志》2008年第3期348-350,共3页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金资助项目(30371430);首都医学发展科研基金资助项目(2002-3037)

摘　　要：目的探讨战士训练后股骨头缺血性坏死（ANFH）的发病机制及体外冲击波疗法（ESWT）的疗效。方法ARCO分期Ⅰ-Ⅲ期的股骨头坏死战士（排除股骨颈骨折后股骨头坏死者）108例,男86例,女22例,年龄18-25岁,由患者自愿选择治疗方法。其中50例采用ESWT联合钻孔减压术治疗,于钻孔减压术后第2天将9-12kV（0.16-0.22mJ/mm^2）的体外冲击波作用于患处,治疗后6、12个月复查双髋X线、MRI及髋关节Harris评分（HHS）。58例患者采用单纯钻孔减压术治疗。对两组治疗结果进行统计学分析。结果随访两组中均无ANFH恶化。ESWT治疗后ARCOⅠ、Ⅱ、Ⅲ期病例股骨头坏死区分别减小了22.9%、32.8%、34.3%,其中ARCOⅡ、Ⅲ期改善程度明显优于单纯钻孔减压治疗组（P〈0.01）。治疗后6、12个月复查显示,ESWT联合钻孔减压治疗组HHS升高较早、较快,由54.2分分别升至90.2、83.2分,疗效优于单纯钻孔减压治疗,其中ARCOⅡ、Ⅲ期改善程度明显优于单纯钻孔减压治疗组（P〈0.01）。结论ESWT对早中期ANFH疗效显著,有望在临床治疗骨肌系统慢性损伤性训练伤中发挥更为积极的作用。Objective To explore the pathogenesis of femoral head ischemic necrosis （FHIN）, and to observe the clinical therapeutic effects of extracorporeal shock waves therapy （ESWT） for FHIN in soldiers. Methods With exclusion of the femoral head necrosis sabsequent to femoral neck fracture, 108 cases of FHIN in ARCO stage Ⅰ-Ⅲ period, induding 86 males and 22 females, with aged ranged from 17 to 25 years, were involved in the present study, and the treatment modality was chosen by patients voluntarily. In 50 patients, ESWT combined with drilling decompression procedure （ESWT group） was chosen, and 9-12kV （0. 16-0. 22mJ/mm^2） of extracorporeal shock wave was applied on the second day after drilling decompression. X-ray and MRI of bilateral hip joints were taken and Harris hip score （HHS） was estimated at 6 and 12 months after treatment. 58 patients chose the treatment of simple drilling decompression served as controls, The results of the two groups were analyzed by Student＇s paired t test. Results No aggravation of FHIN occurred in the two groups. The average ratio of necrosis zone in ESWT group was diminished by 22, 9%, 32, 8% and 34, 3%, respectively, in the stages of ARCO Ⅰ, Ⅱ and Ⅲ, and the improvement was better in ARCO Ⅱ and Ⅲ stages than that in control group （ P〈0. 01）, Compared with that before treatment, the HHS was raised from 54. 2 to 90, 2 and 83. 2 points at 6 and 12 months after treatment in ESWT group, and the improvement of ARCO Ⅱ and Ⅲ period was also better than that in control group （ P〈0. 01）. Conclusions ESWT is an effective treatment for FHEN in the early and intermediate stages, It may play a better role in the clinical treatment of chronic bone and muscle injury induced by intensive military training.

关 键 词：体外冲击波疗法 股骨头坏死 军事人员 

分 类 号：R681.22[医药卫生—骨科学]