Tan Han, Tang Peiyuan, Chai Hua, Ma Wenbo, Cao Yangbin, Lin Bin, Zhu Ying, Xiao Wenfeng, Wen Ting, Li Yusheng
Department of Orthopedics, Xiangya Hospital, Central South University, Changsha.
Xiangya School of Medicine, Central South University, Hunan.
Int J Surg. 2025 Jan 1;111(1):1144-1153. doi: 10.1097/JS9.0000000000001836.
Extracorporeal shockwave therapy (ESWT) is a traditional noninvasive therapy to treat osteonecrosis of the femur head (ONFH). This systematic review aims to investigate whether ESWT can improve the clinical function of ONFH and whether differences in improvement can be observed in radiographic outcomes.
Two authors independently searched PubMed, Embase, Cochrane Library, and Web of Science for English articles until 21 October 2023. After screening and reading the literature, the two authors independently used corresponding scales to evaluate the quality of the included articles and extracted data. The key data extracted included the Harris Hip Score (HHS), Visual Analog Scale (VAS), changes in lesion size, the change in the Association Research Circulation Osseous (ARCO) stage, and bone marrow edema (BME) stage.
Nine articles included 468 males and 248 females. The average age was 43.29 years and the mean follow-up time was 15.19 months. After receiving ESWT, five studies involving 146 hips showed a higher HHS (MD=-33.38; 95% CI: -46.31, -20.45), and the difference was statistically significant ( P <0.00001). The average VAS before treatment was above 5, but it dropped to 1.2 after ESWT (MD=4.64; 95% CI: 3.63-5.64), and the difference was statistically significant ( P <0.00001). Three studies found no significant differences in the areas of femoral head necrosis before and after treatment with ESWT(MD=9.66; 95% CI: -0.36, 19.67; P =0.06; I2 =84%). Two articles showed that the use of ESWT had no significant effect on the change in the ARCO stage (MD=1.11; 95% CI: 0.76-1.62; P =0.60; I2 =0%). Three studies indicated that using ESWT could improve the BME symptom in the early stage of ONFH (MD=4.35; 95% CI: 1.32-14.37; P =0.02; I2 =62%).
Based on the current evidence, ESWT shows promise as a therapy to enhance hip function and alleviate pain in the early stage of ONFH. With the advancement of more precise imaging techniques, ESWT can potentially reduce the area affected by ONFH. However, such reduction was not found to be statistically significant at the imaging level. Additionally, ESWT could improve symptoms of BME in the early stage. However, no significant change in ARCO grade was observed with ESWT treatment.
体外冲击波疗法（ESWT）是治疗股骨头坏死（ONFH）的一种传统非侵入性疗法。本系统评价旨在研究ESWT是否能改善ONFH的临床功能，以及在影像学结果上是否能观察到改善差异。
两位作者独立检索了PubMed、Embase、Cochrane图书馆和Web of Science，查找截至2023年10月21日的英文文章。在筛选和阅读文献后，两位作者独立使用相应量表评估纳入文章的质量并提取数据。提取的关键数据包括Harris髋关节评分（HHS）、视觉模拟评分（VAS）、病变大小变化、骨循环研究协会（ARCO）分期变化以及骨髓水肿（BME）分期。
9篇文章纳入了468例男性和248例女性。平均年龄为43.29岁，平均随访时间为15.19个月。接受ESWT后，5项涉及146个髋关节的研究显示HHS更高（MD=-33.38；95%CI：-46.31，-20.45），差异具有统计学意义（P<0.00001）。治疗前平均VAS高于5，但ESWT后降至1.2（MD=4.64；95%CI：3.63 - 5.64），差异具有统计学意义（P<0.00001）。3项研究发现ESWT治疗前后股骨头坏死面积无显著差异（MD=9.66；95%CI：-0.36，19.67；P =0.06；I2 =84%）。2篇文章显示使用ESWT对ARCO分期变化无显著影响（MD=1.11；95%CI：0.76 - 1.62；P =0.60；I2 =0%）。3项研究表明使用ESWT可改善ONFH早期的BME症状（MD=4.35；95%CI：1.32 - 14.37；P =0.02；I2 =62%）。
基于当前证据，ESWT有望作为一种增强髋关节功能和缓解ONFH早期疼痛的疗法。随着更精确成像技术的进步，ESWT可能会减少ONFH的受影响面积。然而，在影像学水平上未发现这种减少具有统计学意义。此外，ESWT可改善早期BME症状。然而，ESWT治疗后ARCO分级未观察到显著变化。
