Department of Orthopaedic Surgery, Advanced Medical Center, Riyadh, Saudi Arabia.
Department of Radiology and Medical Imaging, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Int Orthop. 2023 Dec;47(12):2953-2960. doi: 10.1007/s00264-023-05904-9. Epub 2023 Jul 27.
As most of the cases of avascular necrosis (AVN) in Saudi Arabia is seen in young population and as literature showed good effect of extracorporeal shock wave therapy (ESWT) in reducing pain and oedema in avascular necrosis and delaying the need of surgical intervention. Our purpose of this study is to assess the effectiveness of ESWT in reducing pain, improving range of motion (ROM) and delaying the surgical intervention in patient with AVN of femoral head and compare our results to published literature.
We have treated 24 patients, 13 males and 11 females with a mean age of 29 years (range 14-48) with 34 hips affected. There were 14 unilateral and ten bilateral lesions. In our series 11 out of 24 patients (45.8%) were due to sickle cell disease. Other causes included idiopathic in five patients (20.8%), corticosteroids use and systemic lupus erythematous in three patients each (12.5% each) and post-traumatic AVN in two patients (8.3%). Extracorporeal shock wave therapy was implanted in FICAT stage I, II and III. All patients had two sessions of extracorporeal shock wave therapy, four to six weeks apart, each with 4000 impulses divided into four points. Radiological and MRI assessment were performed at regular time intervals with a minimum follow-up of two years. Clinical assessment was based on Visual Analog Scale and Harris Hip Score (HHS). The end point outcome measurement was the need for any operative intervention.
Operative intervention was necessary in eight out of 34 hips (23.5%), within an average of 2.5 years (range 1 to 5 years). A hip salvage was achieved in 76.5%. Function was improved with the Harris Hip Score from a mean of 54.6 to 80.4 (P value using paired t test ≤ 0.05). Pain assessed with Visual Analog Scale improved from 5.73 to 2.75 (P value using paired t test ≤ 0.05).
We do recommend the use of ESWT in treating AVN of bone whether of femoral head or other sites prior to the collapse of the articular surface. Further studies are needed to compare using two or more sessions as well as using four or six points for ESWT.
在沙特阿拉伯，大多数缺血性坏死（AVN）病例发生在年轻人群中，并且文献表明体外冲击波疗法（ESWT）在减轻缺血性坏死的疼痛和水肿以及延迟手术干预方面具有良好的效果。我们这项研究的目的是评估 ESWT 在减轻疼痛、改善髋关节活动度（ROM）和延迟股骨头 AVN 患者手术干预方面的有效性，并将我们的结果与已发表的文献进行比较。
我们治疗了 24 名患者，13 名男性和 11 名女性，平均年龄 29 岁（范围 14-48 岁），34 髋受累。其中 14 例为单侧，10 例为双侧病变。在我们的系列中，24 例患者中有 11 例（45.8%）是由于镰状细胞病引起的。其他原因包括特发性 5 例（20.8%）、皮质类固醇使用和系统性红斑狼疮各 3 例（各 12.5%）以及创伤后 AVN 2 例（8.3%）。体外冲击波疗法在 FICAT Ⅰ、Ⅱ和Ⅲ期植入。所有患者均接受了两次体外冲击波治疗，间隔 4-6 周，每次 4000 次脉冲，分为 4 点。定期进行影像学和 MRI 评估，随访时间至少为 2 年。临床评估基于视觉模拟评分和髋关节 Harris 评分（HHS）。终点测量结果是任何手术干预的需要。
34 髋中有 8 髋（23.5%）需要手术干预，平均时间为 2.5 年（范围 1-5 年）。76.5%的髋关节得以挽救。髋关节 Harris 评分从平均 54.6 分提高到 80.4 分（配对 t 检验 P 值≤0.05），功能得到改善。视觉模拟评分疼痛从 5.73 分改善到 2.75 分（配对 t 检验 P 值≤0.05）。
我们建议在股骨头或其他部位的关节面塌陷之前，使用 ESWT 治疗 AVN。需要进一步研究比较使用两次或更多次 ESWT 以及使用四点或六点进行治疗的效果。
