体外冲击波治疗髋关节置换后疼痛  

Extracorporeal shock wave treatment for pain following hip replacement

作　　者：邢林卿[1] 谭金海[1] 雷鹏程[1] 娄文杰[1] 

机构地区：[1]武汉大学中南医院骨科,湖北省武汉市430071

出　　处：《中国组织工程研究与临床康复》2008年第48期9533-9536,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:髋关节置换后髋部疼痛逐渐成为困扰患者和骨外科医生的棘手问题,如行关节翻修术则将再次给患者造成严重创伤,而体外冲击波治疗肢体疼痛已取得良好的临床疗效。目的:观察验证体外冲击波对髋关节置换后疼痛的治疗效果。设计、时间及地点:病例自身对照,双盲评估,于2004-06/2008-02在武汉大学中南医院骨科完成。对象:选择髋关节置换后疼痛患者51例(61髋),根据病因分组,骨水泥组骨溶解松动16例(20髋),非骨水泥组骨溶解松动12例(16髋),异位骨化组8例(10髋),急性感染组4例(4髋),慢性感染组5例(5髋),软组织无菌性炎症组4例(4髋),髋臼脱位组2例(2髋)。方法:患者接受体外冲击波治疗,电压12kV,3次/s,每次冲击4000次,能量0.54～1.06MJ/mm2,1次/周,连续8～12周。主要观察指标:治疗前后采用目测类比评分法评价疼痛程度,Harris评分评价髋关节功能,X射线观察假体周围骨量变化。结果:51例患者随访时间18～64个月,平均4.1年,2例死亡。治疗后非骨水泥组、慢性感染组、异位骨化组、软组织无菌性炎症组目测类比评分显著低于治疗前(P<0.01)。治疗后骨水泥组、非骨水泥组、慢性感染组、异位骨化组及软组织无菌性炎症组Harris评分显著高于治疗前(P<0.01)。X射线提示假体与骨的界面有新骨形成,假体与髋臼或股骨干之间骨溶解形成的透亮带宽度由治疗前平均3.1mm减小到治疗后1.2mm,部分患者出现局部红肿,休息后缓解。结论:体外冲击波是治疗由于松动、感染、软组织炎症、异位骨化引起的髋关节置换后疼痛的有效方法。BACKGROUND： Pain after hip replacement is a difficulty for orthopedic surgeons, and revision surgery might result in severe wound for patients undergoing hip replacement. Extracorporeal shock wave （ESWT） is certificated effective for relieving pain. OBJECTIVE： To evaluate the effects of ESWT on the pain after hip replacement. DESIGN, TIME AND SETTING： Case self-control, double-blind evaluation. The experiment was performed at the Depaatment of Orthopaedics, Zhongnan Hospital, Wuhan University between June 2004 and February 2008. PARTICIPANTS： Fifty-one cases （61 hips） undergoing total hip replacement with pain were selected, including prosthetic loosening （cemented： 16 cases, 20 hips; non-cement： 12 cases, 16 hips）, ectopic ossification （8 cases, 10 hips）, acute infection （4 cases, 4 hips）, chronic infection （5 cases, 5 hips）, soft tissue aseprtic inflammation （4 cases, 4 hips） and acetabulum dislocation （2 cases, 2 hips）. METHODS： These patients received sessions of ESWT （4 000 shocks, 3 times/s）, with an energy ranging from 0.54 to 1.06 MJ/mm2, once a week for 8-12 weeks. MAIN OUTCOME MEASURES： Visual analog scale （VAS）, Harris hip scores, diversity of the sclerotin surrounding the prosthesis （X-my）. RESULTS： The 51 patients were followed up for 18-64 months （4.1years in average）, and 2 died during this period. The scores of VAS in non-cement, chronic infection, ectopic ossification and soft tissue aseprtic inflammation groups were significantly decreased than before treatment （P 〈 0.01）. A significant increase was found in Harris hip scores of cemented, non-cement, chronic infection, ectopic ossification and soft tissue aseprtic inflammation groups after treatment （P 〈 0.01）. X-ray showed that new bone formed between bone and prosthesis, and the radiotmsparent width between the prosthesis and acetabulum was decreased from preoperative 3.1 mm to postoperative 1.2 rnm. Local swelling occurred in several patients, and recovered after a

关 键 词：体外冲击波 髋关节置换 疼痛 

分 类 号：R681[医药卫生—骨科学]