C形臂X线定位下多次小直径钻孔联合体外冲击波疗法治疗早期股骨头坏死的疗效观察  

Clinical application study of multiple small-diameter drilling combined with extracorporeal shock wave therapy(ESWT)under C-arm positioning in the treatment of early femoral head necrosis

作　　者：刘海军 王前源 牛存良 汪庚申 黄国源 LIU Hai-jun;WANG Qian-yuan;NIU Cun-liang;WANG Geng-shen;HUANG Guo-yuan(Department of Orthopaedics,Wuwei People's Hospital,Wuwei 733000,Gansu,China)

机构地区：[1]武威市人民医院骨二科,甘肃武威733000

出　　处：《中国骨伤》2023年第11期1014-1020,共7页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探究C形臂X线定位下多次小直径钻孔联合体外冲击波疗法(extracorporeal shock wave therapy,ESWT)对早期股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。方法:回顾分析2015年5月至2017年5月收治的早期ONFH患者106例,其中53例采用C形臂X线定位下多次小直径钻孔联合ESWT治疗作为观察组,男41例,女12例,年龄22~70(45.85±6.01)岁;另外53例仅采用ESWT治疗作为对照组,男34例,女19例,年龄20~68(45.12±5.83)岁。观察比较两组患者治疗前后髋关节屈曲范围、外展内收活动范围、ONFH面积比例,比较两组治疗前后改良Harris评分(modified Harris hip scores,mHHS),视觉模拟评分(visual analog scale,VAS)。采用Kaplan-Meier法绘制生存曲线,比较两组患者治疗后3年随访期间的股骨头生存率。结果:患者均无创口愈合不良及感染等并发症的发生。106例患者均获得随访,时间28~36(31.06±4.28)个月。观察组mHHS总分、髋关节屈曲范围、髋关节外展内收活动范围由治疗前(63.85±5.42)分、(23.79±2.21)°、(32.40±4.19)°分别增加至治疗后2年的(85.51±5.69)分、(34.65±2.73)°、(43.32±5.71)°(P<0.05);对照组分别由治疗前的(64.73±5.64)分、(23.82±2.18)°、(32.45±4.13)°增加至治疗后2年的(81.65±5.48)分、(32.79±2.87)°、(39.75±5.68)°(P<0.05)。观察组VAS、ONFH面积比例分别由治疗前的(5.76±1.41)分、(35.07±4.96)%降低至治疗后2年的(3.39±1.02)分、(22.04±3.23)%(P<0.05),对照组分别由治疗前的(5.73±1.45)分、(35.24±5.18)%降低至治疗后2年的(4.43±1.21)分、(28.32±3.76)%(P<0.05);治疗后两组间各项指标比较,差异均有统计学意义(P<0.05)。观察组患者治疗后3年的股骨头生存率明显高于对照组(P<0.05)。结论:C形臂X线定位下多次小直径钻孔联合ESWT治疗早期ONFH能够明显改善患者的临床症状,缓解疼痛,提高临床疗效。Objective To explore the therapeutic effect of multiple small diameter drilling combined with extracorporeal shock wave therapy(ESWT)under C-arm X-raylocalization in patients with early osteonecrosis of the femoral head(ONFH).Methods A total of 106 cases of early ONFH patients admitted from May 2015 to May 2017 were retrospectively selected as the study subjects.According to different treatment methods,the patients were divided into observation group and control group,53 cases in each group.The observation group was treated with multiple small-diameter drilling combined with ESWT under C-arm positioning in the observation group,including 41 males and 12 females with an age of(45.85±6.01)years old(22 to 70 years old);and the control group was treated with ESWT,including 34 males and 19 females with an age of(45.12±5.83)years old(20 to 68 years old)in the control group.The modified Harris hip scores(mHHS),visual analog scale(VAS),hip flexion range,hip abduction and adduction range,ONFH area ratio and clinical efficacy were compared between twe groups before and after treatment.Kaplan-Meier method was used to draw a survival curve to compare the femoral head survival rate between two groups during the 3-year follow-up period after treatment.Results There were no complications such as poor wound healing and infection.All of 106 patients were followed up for 28 to 36 months with an average of(31.06±4.28)months.MHHS score,hip flexion range and hip abduction and adduction range in the observation group were increased from(63.85±5.42)scores,(23.79±2.21),(32.40±4.19)before treatment to(85.51±5.69)scores,(34.65±2.73)°,(43.32±5.71)°at 2 years after treatment,respectively(P<0.05).The above indicators in the control group increased from(64.73±5.64)°,(23.82±2.18)°,(32.45±4.13)°before treatment to(81.65±5.48)scores,(32.79±2.87)°,(39.75±5.68)°at two years after treatment,respectively(P<0.05).VAS score and ONFH area ratio in the observation group decreased from(5.76+1.41)scores and(35.07±4.96)%before treatm

关 键 词：体外冲击波疗法 股骨头坏死 临床疗效 

分 类 号：R687.4[医药卫生—骨科学]