体外冲击波疗法结合同种异体骨钉治疗成人股骨头缺血性坏死

目的探讨体外冲击波疗法（ESWT）结合同种异体骨钉治疗成人股骨头缺血性坏死的疗效。方法2003年7月～2007年1月，采用体外冲击波或结合同种异体皮质骨钉植入术治疗54例（84髋）股骨头缺血性坏死患者并随访观察。男41例，女13例；年龄20～61岁，平均30岁。按Ficat分期，Ⅱ期55髋，Ⅲ期29髋。其中40髋（Ⅱ期27髋，Ⅲ期13髋），采用ESWT结合同种异体骨钉治疗，治疗后6、12、24个月复查双髋X线、MRI及髋关节Harris评分（HHS）。44髋（Ⅱ期28髋，Ⅲ期16髋）患者采用单纯ESWT治疗。对两组治疗结果进行统计学分析。结果随访24～29个月，平均25．7个月。二者治疗后Harris评分分别为83．71±18．76和57．20±12．82，二者比较差异有统计学意义妒〈0．01）：影像学X光片评估：ESWT结合同种异体骨钉术后随访股骨头塌陷12髋，塌陷率为30％，单纯ESWT治疗随访股骨头塌陷25髋，塌陷率为56．8％。结论体外冲击波疗法结合同种异体骨钉是治疗中期ONFH的方法之一，它不但具有冲击波疗法促进骨愈合作用，而且复合骨钉移植可起到骨传导及骨支撑作用，近期可以减少股骨头塌陷发生。

Extracorporeal Shock Waves Therapy With Allogous Bone Nail For The Treatment Of Osteonecrosis Of The Femoral Head

Objective To explore the midterm efficacy of extracorporeal shock waves therapy with allogous bone nail for the treatment of osteonecrosis of femoral head （ONFH）. Methods From July 2003 to January 2007, 54 patients （84 hips） of ONFH were treated with Allogous Bone Nail and or ESWT .Among 54 patients, 41 patients were male and 13 patients were female, aged from 20 to 61 with an average of 30 years old. 55 hips were classified as Ficat Stage II and 29 as StagelII. 40 hips （Groupl） were treated with ESWT and allogous bone nail, 44 hips （Group2） were treated with ESWT only. X-ray and MRI were taken and Harris hip score （HHS） was estimated at 6,12 and 24 months after treatment Results Postoperatively, the patients were followed up for 24 to 29 months with an average of 25.7months. Harris score s were 80.78 ± 18.77 and 57.20 ± 12.82 in two groups respectively. The differences between the two techniques were statistically significant（P 〈 0.01 ）. 12 hips had development of femoral head collapse and a 30% rate of femoral head collapse were found in Groupl.By contrast, 25 hips and a 56.8% rate of femoral head collapse in Group2. Conclusion Extracorporeal shock waves with allogous bone nail is one of alternative treatments for ONFH at midterrn stages. It is able to prevent advanced collapse of the femoral head resently. The mechanisms involved that ESWT may enhance bone regeneration and allogous bone nail may promto the osteoconduction and bone augmentation.