体外冲击波修复重建骨组织结构治疗股骨头缺血性坏死的临床应用

Clinical application of extracorporeal shock wave to repair and reconstruct osseous tissue framework in the treatment of avascular necrosis of the femoral head (ANFH)

目的:探讨体外冲击波疗法促进修复重建骨组织结构治疗股骨头缺血性坏死的应用价值。方法:选择2006年3月至2008年3月CR、MRI诊断的股骨头缺血性坏死36例(42髋)应用体外冲击波治疗,男29例,女7例;年龄21～66岁,平均42.9岁;病程6个月～3年,平均1.3年。Ficat分期为Ⅰ、Ⅱ、Ⅲ期的患者分别为8、25、9髋,能量密度为0.18～0.25mJ/mm2。方法以X线透视股骨头坏死区在体表投影为中心选取1～2个冲击点为定位聚焦,每个冲击点每次冲击400～500次,每次间隔7d,共治疗3～5次。治疗前及治疗3、12个月后髋关节行X线、CT或MR检查及髋关节Harris评分,观察冲击波修复重建股骨头骨组织结构及改善髋关节功能方面的疗效。结果:42髋股骨头缺血性坏死经冲击波治疗,X线、CT或MR复查,35髋取得了良好的效果,其中治愈6髋,显效13髋,有效16髋,无效7髋。经随访1年后观察无复发,无股骨头进一步塌陷现象。治疗后3个月Ⅰ、Ⅱ、Ⅲ期髋关节Harris评分总均分分别为(90.1±5.4)、(81.2±4.5)、(66.9±5.6)分;治疗后12个月Ⅰ、Ⅱ、Ⅲ期髋关节Harris评分总均分分别为(91.6±5.4)、(91.1±5.5)、(79.0±6.1)分。均较治疗前总均分提高。结论:体外冲击波可促进修复重建骨组织结构,提高髋关节Harris评分及改善关节功能,是一种疗效明显、无创伤、并发症少、简便易行的治疗股骨头缺血性坏死的方法。

Objective ：To investigate the application value of extracorporeal shock wave to repair and reeonstruet osseous tissue for the treatment of avascular necrosis of the femoral head （ANFH）. Methods：A total of 42 hips of 36 patients with ANFH were treated with extraeorporeal shock waves included 29 males and 7 females ,aged from 21 to 66 during March 2006 to March 2008. The course of disease was 6 months to 3 years （means 1.3 years）. According to Ficat classification 8 hips were in stages I , 25 were in stage 1I , and 9 were in stage III. The energy density of ESWT was from 0.18 to 0.25 m J/mm^2. The treatment focusing points of avascular necrosis of the femoral on the surface projection were marked with X-ray fluoroscopy, and 1 to 2 points were selected for one treatment with 400 to 500 pulses in each point. Generally 3 to 5 treatments were performed ,once per 7 days. The CR, CT or MRI and the hip Harris score were obtained to investigate the clinical effects of extracorporeal shock wave for repair and reeonstruet osseous tissue framework and improve the hip function before treatment and at 3,12 months after treatment. Results： The X-ray, CT or MR were performed of 42 hips, 35 hips were treated successfully after extraeorporeal shock wave therapy, cure occurred in 6 cases, marked effect in 13 cases, effectiveness in 16 cases and ineffectiveness in 7 case. After one years of followed-up, no relapse was found, the femoral head further collapse did not occur. The Harris hip score of stage I , II, IIIwere respectivey（90.1±5.4）, （81.2±4.5）, （66.9±5.6） at 3 months and（91.6±5.4）, （91.1±5.5）, （79.0±6.1） at 12 months after treatment. The scores after treatment were increased significantly than that of before treatment （P〈0.01）. Conclnsion：Extraeorporeal shock wave therapy has obviously therapeutic effect in the repairing and reconstructing osseous tissue and improve the hip Harris score and improve the hip function. It is a effect significantly, non-invasion, less complications, simple-accurate therapy method for ischemic necrosis of the femoral head.