体外冲击波和髓芯减压术治疗早期股骨头坏死远期临床疗效的比较研究

Long-term curative effect of extracorposreal shock waves and core decompression for early-stage femoral head necrosis

目的比较体外冲击波和髓芯减压术治疗创伤等导致的早期股骨头坏死的远期临床疗效。方法选取2006年1月~2009年1月收治的132例早期股骨头坏死患者,按治疗方法不同分为体外冲击波治疗组和髓芯减压术治疗组,其中体外冲击波治疗组69例(79髋),髓芯减压术治疗组63例(82髋)。观察和比较两组患者的临床疗效,记录治疗前、治疗后3个月以及末次随访的VAS评分,利用髋关节Harris评分对患者进行髋关节功能评价,记录股骨头生存时间。结果所有患者均获得80~113个月随访,平均96个月。两组患者的年龄、随访时间及治疗前VAS评分与Harris评分比较差异无统计学意义(P>0.05)。体外冲击波治疗组患者治疗后3个月和末次随访的VAS评分均显著优于髓芯减压术治疗组(P<0.05);体外冲击波治疗组患者术后3个月和末次随访的Harris评分均显著高于髓芯减压术治疗组(P<0.05);体外冲击波治疗组的总优良率为82.28%,显著高于髓芯减压术治疗组60.98%(P<0.05);体外冲击波治疗组患者股骨头平均生存时间显著长于髓芯减压术治疗组(P<0.05)。结论体外冲击波和髓芯减压术治疗创伤等导致的早期股骨头坏死均能取得一定的远期临床疗效。体外冲击波能更好地改善患者的髋关节功能,对早期股骨头坏死的临床疗效优于髓芯减压术疗法。

Objective To study the comparison of extracorposreal shock waves with core decompression for early-stage trauma-induced femoral head necrosis. Methods Totally 132 cases of patients admitted in our hospital from Jan. 2006 to Jan. 2009 were randomly divided into extracorposreal shock waves group （ 69 cases, 79 hips ） and core decompression group （ 63 cases, 82 hips）. The clinical effect between the two groups was observed and compared. VAS score was recorded before treatment,3 months after treatment and at the last follow up. Harris scoring system was used to evaluate hip functions. The survival time of femoral head was recorded. Results The mean duration of follow up was 96 months,ranging from 80 to 113 months. There was no significant difference in age,duration of follow up, VAS and Harris scores between the two groups before treatment （ P 〉 0. 05 ）. The VAS scores in extracorposreal shock waves group 3 months after treatment and at the last follow up were significantly lower than those in the core decompression group （ P 〈 0. 05 ）. The Harris scores in extracorposreal shock waves group 3 months after treatment and at the last follow up were significantly higher than those in the core decompression group （ P 〈 0. 05 ）. The total excellent and good rate in extracorposreal shock waves group was 82. 28% ,which was significantly higher than that in the core decompression group （ 60. 98 % , P 〈 0. 05 ）. The average survival time of femoral head in extracorposreal shock waves group was significantly longer than that in the core decompression group （ P 〈 0.05 ）. Conclusion Long-term curative effect was good in both extracorposreal shock waves group and core decompression group. Extracorposreal shock waves improved the hip function better than core decompression. Clinical effect of extracorposreal shock waves treatment was better than core decompression in the treatment of early-stage trauma-induced femoral head necrosis.