Liu Hai-Jun, Wang Qian-Yuan, Niu Cun-Liang, Wang Geng-Shen, Huang Guo-Yuan
Department of Orthopaedics, Wuwei People's Hospital, Wuwei 733000, Gansu, China.
Zhongguo Gu Shang. 2023 Nov 25;36(11):1014-20. doi: 10.12200/j.issn.1003-0034.2023.11.002.
To explore the therapeutic effect of multiple small diameter drilling combined with extracorporeal shock wave therapy (ESWT) under C-arm X-raylocalization in patients with early osteonecrosis of the femoral head (ONFH).
A total of 106 cases of early ONFH patients admitted from May 2015 to May 2017 were retrospectively selected as the study subjects. According to different treatment methods, the patients were divided into observation group and control group, 53 cases in each group. The observation group was treated with multiple small-diameter drilling combined with ESWT under C-arm positioning in the observation group, including 41 males and 12 females with an age of (45.85±6.01) years old (22 to 70 years old);and the control group was treated with ESWT, including 34 males and 19 females with an age of (45.12±5.83) years old(20 to 68 years old) in the control group. The modified Harris hip scores(mHHS), visual analog scale(VAS), hip flexion range, hip abduction and adduction range, ONFH area ratio and clinical efficacy were compared between twe groups before and after treatment. Kaplan-Meier method was used to draw a survival curve to compare the femoral head survival rate between two groups during the 3-year follow-up period after treatment.
There were no complications such as poor wound healing and infection. All of 106 patients were followed up for 28 to 36 months with an average of (31.06±4.28) months. MHHS score, hip flexion range and hip abduction and adduction range in the observation group were increased from (63.85±5.42) scores, (23.79±2.21) °, (32.40±4.19) ° before treatment to (85.51±5.69) scores, (34.65±2.73)°, (43.32±5.71)° at 2 years after treatment, respectively(<0.05). The above indicators in the control group increased from (64.73±5.64)°, (23.82±2.18)°, (32.45±4.13)° before treatment to (81.65±5.48) scores, (32.79±2.87)°, (39.75±5.68)°at two years after treatment, respectively(<0.05). VAS score and ONFH area ratio in the observation group decreased from (5.76±1.41) scores and (35.07±4.96)% before treatment to (3.39±1.02) scores and (22.04±3.23)% at 2 years after treatment, respectively(<0.05). The above indicatiors in control group decreased from (5.73±1.45) scores and (35.24±5.18)% before treatment to (4.43±1.21) scores and (28.32±3.76)% at 2 years after treatment, respectively(<0.05), and the improvement in the observation group was significantly higher than that in the control group(<0.05). At 3 years after treatment, the femoral head survival rate in the observation group was higher than that in the control group (<0.05).
Multiple small diameter drilling combined with ESWT under C-arm positioning can significantly improve the clinical symptoms of patients with early ONFH, relieve pain and improve clinical efficacy.
探讨C型臂X线定位下多枚小直径钻孔联合体外冲击波疗法（ESWT）治疗早期股骨头坏死（ONFH）患者的疗效。
回顾性选取2015年5月至2017年5月收治的106例早期ONFH患者作为研究对象。根据治疗方法不同，将患者分为观察组和对照组，每组53例。观察组采用C型臂定位下多枚小直径钻孔联合ESWT治疗，其中男性41例，女性12例，年龄（45.85±6.01）岁（22至70岁）；对照组采用ESWT治疗，其中男性34例，女性19例，年龄（45.12±5.83）岁（20至68岁）。比较两组治疗前后的改良Harris髋关节评分（mHHS）、视觉模拟评分（VAS）、髋关节屈曲范围、髋关节外展和内收范围、ONFH面积比及临床疗效。采用Kaplan-Meier法绘制生存曲线，比较两组治疗后3年随访期内的股骨头生存率。
未出现伤口愈合不良、感染等并发症。106例患者均获随访，随访时间28至36个月，平均（31.06±4.28）个月。观察组治疗后2年mHHS评分、髋关节屈曲范围、髋关节外展和内收范围分别由治疗前的（63.85±5.42）分、（23.79±2.21）°、（32.40±4.19）°提高至（85.51±5.69）分、（34.65±2.73）°、（43.32±5.71）°（均P<0.05）。对照组上述指标分别由治疗前的（64.73±5.64）分、（23.82±2.18）°、（32.45±4.13）°提高至治疗后2年的（81.65±5.48）分、（32.79±2.87）°、（39.75±5.68）°（均P<0.05）。观察组治疗后2年VAS评分、ONFH面积比分别由治疗前的（5.76±1.41）分、（35.07±4.96）%降至（3.39±1.02）分、（22.04±3.23）%（均P<0.05）。对照组上述指标分别由治疗前的（5.73±1.45）分、（35.24±5.18）%降至治疗后2年的（4.43±1.21）分、（28.32±3.76）%（均P<0.05），且观察组改善程度明显高于对照组（P<0.05）。治疗后3年，观察组股骨头生存率高于对照组（P<0.05）。
C型臂定位下多枚小直径钻孔联合ESWT可显著改善早期ONFH患者的临床症状，缓解疼痛，提高临床疗效。
