早期自发性膝关节骨坏死的保守治疗：脉冲电磁场治疗。

Conservative treatment of spontaneous osteonecrosis of the knee in the early stage: pulsed electromagnetic fields therapy.

机构信息

Isituto Ortopedico Rizzoli, University of Bologna, III Orthopaedic and Traumatologic Clinic and Biomechanics Laboratory Via di Barbiano, 1/10, 40136 Bologna (BO), Italy.

出版信息

Eur J Radiol. 2013 Mar;82(3):530-7. doi: 10.1016/j.ejrad.2012.11.011. Epub 2012 Dec 3.

DOI:10.1016/j.ejrad.2012.11.011

PMID:23219192

Abstract

HYPOTHESIS

pulsed electromagnetic fields treatment might improve symptoms in the early stage of spontaneous osteonecrosis of the knee.

METHODS

Twenty-eight patients (19M/9F, age 49.8±16.4 years) suffering from symptomatic (pain) Koshino stage I spontaneous osteonecrosis of the knee, confirmed by magnetic resonance imaging (MRI) were treated with local pulsed electromagnetic fields therapy (6 h daily for 90 days). Clinical evaluation: baseline, 6- and 24-month follow-up by VAS for pain, knee society score (KSS), Tegner and EQ-5D scales. MRI evaluation: baseline and 6-month follow-up, measuring bone marrow lesion's areas and grading these lesions by WORMS score. Failures: patients undergoing knee arthroplasty.

RESULTS

Pain significantly reduced at 6 months (from 73.2±20.7 to 29.6±21.3, p<0.0001), which remained almost unchanged at final follow-up (27.0±25.1). KSS significantly increased in first 6 months (from 34.0±13.3 to 76.1±15.9, p<0.0001) and was slightly reduced at final follow-up (72.5±13.5, p=0.0044). Tegner median level increased from baseline to 6-month follow-up (1(1-1) and 3(3-4), respectively, p<0.0001) and remained stable. EQ-5D improved significantly throughout the 24 months (0.32±0.33, baseline; 0.74±0.23, 6-month follow-up (p<0.0001); 0.86±0.15, 24-month follow-up (p=0.0071)). MRI evaluation: significant reduction of total WORMS mean score (p<0.0001) and mean femoral bone marrow lesion's area (p<0.05). This area reduction was present in 85% and was correlated to WORMS grading both for femur, tibia and total joint (p<0.05). Four failures (14.3%) at 24-month follow-up.

CONCLUSIONS

Pulsed electromagnetic fields stimulation significantly reduced knee pain and necrosis area in Koshino stage I spontaneous osteonecrosis of the knee already in the first 6 months, preserving 86% of knees from prosthetic surgery at 24-month follow-up. No correlation was found between MRI and clinical scores.

LEVEL OF EVIDENCE

Level IV; case series.

摘要

假设

脉冲电磁场治疗可能会改善自发性膝关节骨坏死早期的症状。

方法

28 名（19 名男性/9 名女性，年龄 49.8±16.4 岁）患有 Koshino 期 I 期自发性膝关节骨坏死（通过磁共振成像 [MRI] 证实）且伴有症状（疼痛）的患者接受局部脉冲电磁场治疗（每天 6 小时，持续 90 天）。临床评估：基线、6 个月和 24 个月随访时采用疼痛视觉模拟评分（VAS）、膝关节协会评分（KSS）、Tegner 和 EQ-5D 量表进行评估。MRI 评估：基线和 6 个月随访，测量骨髓病变区域并通过 WORMS 评分对这些病变进行分级。失败：接受膝关节置换术的患者。

结果

疼痛在 6 个月时明显减轻（从 73.2±20.7 降至 29.6±21.3，p<0.0001），在最终随访时几乎保持不变（27.0±25.1）。KSS 在最初的 6 个月内显著增加（从 34.0±13.3 增加到 76.1±15.9，p<0.0001），在最终随访时略有下降（72.5±13.5，p=0.0044）。Tegner 中位数水平从基线到 6 个月随访时升高（分别为 1（1-1）和 3（3-4），p<0.0001），并保持稳定。EQ-5D 在整个 24 个月内显著改善（0.32±0.33，基线；0.74±0.23，6 个月随访（p<0.0001）；0.86±0.15，24 个月随访（p=0.0071））。MRI 评估：WORMS 总评分均值显著降低（p<0.0001）和股骨骨髓病变面积均值降低（p<0.05）。在 85%的病例中观察到这种面积减少，并且与 WORMS 分级均与股骨、胫骨和全关节相关（p<0.05）。24 个月随访时有 4 例（14.3%）失败。