摘要： 目的 回顾性分析放散式体外冲击波疗法（rESWT）治疗中晚期股骨头坏死（ONFH）的临床疗效。方法 选择2016年3月至2021年3月在我院采用rESWT治疗的ONFH Ⅲ~Ⅳ期（Ficat分期）患者19例（25髋）。治疗时分别选用R15、D20及DI15探头，每次给予6 000脉冲，频率10 Hz，2次/周，强度由2.0 bar渐增至5.0 bar，共治疗24次。分别于治疗前、治疗1个月和3个月时，评估髋关节疼痛［视觉模拟评分（VAS） ］、髋关节活动（Harris评分）、髋周肌肉功能［徒手肌力检查（MMT）］。比较治疗前和治疗3个月时数字化X线摄影（DR）的变化情况。结果 与治疗前相比，治疗1个月时VAS评分明显降低（P < 0.001）、髋关节Harris评分及MMT评分显著增加（均P < 0.001）。与治疗1个月相比，治疗3个月时VAS评分、髋关节Harris评分和MMT评分继续显著改善（P < 0.01）。对比治疗前和治疗3个月时患髋DR影像学变化，未见病变进一步发展。结论 rESWT能明显缓解中晚期ONFH患者髋关节疼痛，增加髋关节活动度，改善髋关节功能，对不适合手术的中晚期ONFH患者是一种无不良反应、快速止痛的治疗方式，且效果随治疗时间延长而更佳。

放散式体外冲击波治疗中晚期股骨头坏死的疗效观察

姜冬蕾, 张带, 海虹, 赵迎娱, 马跃文

中国医科大学附属第一医院康复医学科, 沈阳 110001

收稿日期:2021-07-22出版日期:2022-04-20发布日期:2022-05-05
通讯作者:马跃文E-mail:yuewen_m@sina.com
作者简介:姜冬蕾(1987-),女,技师,硕士.



关键词: 股骨头坏死, 放散式体外冲击波, 髋关节
Abstract: Objective To retrospectively analyze the effect of radial extracorporeal shock wave therapy (rESWT) in middle- to late- Ficat stage osteonecrosis of the femoral head (ONFH). Methods We included 19 patients (25 hips) treated with rESWT for middle- to late-Ficat stage ONFH in our hospital between March 2016 and March 2021. rESWT was applied twice weekly with 6 000 pulses at a frequency of 10 Hz. The intensity increased from 2.0 bar to 5.0 bar,for a total of 24 times. Hip pain (Visual Analog Scale,VAS score),hip activity (Harris hip scale),and hip muscle function (manual muscle testing,MMT) were observed before and 1 and 3 months after treatment. Changes in digital radiography (DR) were compared before and 3 months after treatment. Results The VAS score decreased significantly (P < 0.001),whereas the Harris hip and MMT scores increased significantly (both P < 0.01) after 1 month of treatment. VAS,Harris hip scale,and MMT scores significantly improved further after 3 months of treatment (P < 0.01). After 3 months of treatment,there was no further development of hip DR. Conclusion rESWT can significantly relieve pain and improve motor function in patients with middle- to late-stage ONFH. For patients with advanced-stage ONFH who are not suitable for surgery,rESWT is a good treatment method with almost no side effects and rapid pain relief,and the effect is better with longer treatment periods.
Key words: osteonecrosis of the femoral head, radial extracorporeal shock wave, hip
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