导向器镜下精准钻孔减压联合冲击波治疗创伤性股骨头坏死的有效性

Efficacy of guided microscopic precision drilling decompression combined with shock wave in treatment of traumatic avascular necrosis of femoral head

目的探讨精准微创治疗部队官兵创伤性股骨头坏死(avascular necrosis of femoral head,ANFH)的有效性并进行相关分析。方法选取2014-02至2018-04解放军总医院第三医学中心骨科收治的共77例(93髋)ANFH患者,均为部队官兵。随机分为单纯体外冲击波(extracorporeal shock wave therapy,ESWT)治疗组(对照组)46髋,导向器镜下精准钻孔减压联合ESWT治疗组(联合治疗组)47髋,两组患者分别于治疗前、治疗后的3、6个月及最终随访时采用视觉模拟VAS评分和Harris髋关节评分进行主观疼痛和髋关节功能评估,并对两组股骨头塌陷及生存时间情况应用Kaplan-Meier生存曲线分析比记录。结果平均随访时间为72个月,两组治疗前髋关节主观疼痛及功能评价比较无统计学意义,治疗后3、6个月及末次随访的髋关节主观疼痛及功能比较,联合治疗组明显优于对照组,差异有统计学意义(P<0.05),且联合治疗组优良率(85.11%)、股骨头塌陷及生存时间明显优于对照组,差异有统计学意义(χ^(2)=6.948,P=0.016)。结论导向器镜下精准钻孔减压联合ESWT较单纯ESWT治疗,对部队官兵ARCOⅠ-ⅢA期ANFH髋关节功能和延缓股骨头塌陷疗效更为满意。

Objective To explore the effectiveness and related analysis of precise minimally invasive treatment for traumatic avascular necrosis of femoral head(ANFH)in soldiers.Methods Seventy-seven cases(93 hips)admitted in the Orthopedics Department of the Third Medical Center of PLA General Hospital from Feb.2014 to Apr.2018 were randomly divided into the group of extracorporeal shock wave(control group;46 hips)and the group of precise drilling decompression combined with shock wave therapy under hip arthroscopy(combined treatment group;47 hips).Visual Analogue score and Harris Hip score were used to evaluate the pain and hip function of both groups at the time of before treatment,3,6 months and the last followed-up visit after treatment,and Kaplan-Meier survival curve was used to record the collapse and survival time of femoral head of the two groups.Results The mean time follow-up visit was 72 months,and there was no statistically significant comparison of subjective pain and functional evaluation of the hip joint before treatment between the two groups,while those evaluation indicators at 3,6 months and the last follow-up visit after treatment were significantly better in combined treatment group.The excellent rate(85.11%),femoral head collapse and survival time were also significantly better in combined treatment group,with statistically significant differences(χ^(2)=6.948,P=0.016).Conclusions The efficacy of guided microscopic precision drilling decompression combined with shock wave is more satisfactory than shock wave treatment alone for hip function and can delay the femoral head collapse in soldiers with ARCO stageⅠ-ⅢA ANFH.