三联疗法治疗成人早期股骨头坏死的临床疗效

目的 探讨体外冲击波联合高压氧和活血化瘀药物的三联疗法治疗成人早期股骨头坏死的临床疗效。方法 选择骨关节外科股骨头坏死患者30例,ARCO分期分为Ⅰ期17例,Ⅱ期13例,进行体外冲击波联合高压氧和活血化瘀药物的三联疗法治疗,随访时间为3个月,治疗前和3个疗程结束后进行VAS评分、Harris评分、患肢旋股内侧动脉血流阻力指数(RI)、股骨头坏死区域体积占股骨头体积的百分比的计算。结果 同治疗前相比,同一分期治疗后VAS评分和Harris评分降低,P<0.01。而同I期相比,治疗前后II期VAS评分均降低,Harris评分均升高,P<0.05。30例患者中能够探及股骨头旋股内侧动脉血流信号的有20例,其中Ⅰ期13例,Ⅱ期7例。同治疗前相比,同一分期治疗后旋股内侧动脉RI均降低,P<0.05。同治疗前相比,同一分期治疗后股骨头坏死体积所占股骨头体积的百分比降低,P<0.05。而同I期相比,治疗前后II期股骨头坏死体积所占股骨头体积的百分比均升高,P<0.01。结论 三联疗法治疗成人早期股骨头坏死临床疗效显著,Ⅰ期好于Ⅱ期,在临床应用价值巨大。

Clinical study of triple therapy for adult early necrosis of femoral head

Objective To investigate the clinical effect of the triple therapy of extracorporeal shock wave combined with hyperbaric oxygen and blood circulation drugs in the treatment of adult early necrosis of femoral head, so as to provide valuable experience for clinical work.Methods Thirty patients with femoral head necrosis in the department of joint surgery were chosen. ARCO stage was Ⅰ period of 17 cases, Ⅱ period 13 cases, and patients received triple therapy treatment of extracorporeal shock wave combined with hyperbaric oxygen and blood circulation drugs. The patients were followed up for 3 months, and before the treatment and after three periods of treatment, the calculation was performed on VAS scores, Harris scores, limb medial femoral circumflex artery blood flow resistance index (RI), and the percentage of femoral head necrosis volume in overall femoral head volume.Results VAS scores and Harris scores were lower after the same stage of treatment than those before the treatment, P<0.01. Compared with those of stage I, the VAS scores of stage II decreased and Harris scores of stage II increased before and after treatment, P<0.05. The blood flow signal of the medial circumflex femoral artery of the femoral head could be detected in 20 of the 30 patients, includingⅠperiod 13 cases and Ⅱperiod 7 cases. Compared with that before the treatment, RI of medial rotated femoral artery decreased at the same stage, P<0.05. The percentage of femoral head necrosis in femoral head volume was lower after the same stage of treatment than that before the treatment, P<0.05. Compared with that of stage I, the percentage of femoral osteonecrosis volume in stage II increased before and after the treatment, P<0.01.Conclusion Triple therapy for the treatment of early adult femoral head necrosis has clinical curative effect, which was better in Ⅰ period than in Ⅱ period, so it has great clinical application value.