论文部分内容阅读
Purpose: This study investigated the systemic and local effects of different dosages of extracorporeal shockwave therapy(ESWT)in early osteonecrosis of the femoral head(ONFH).Materials and Methods: Thirty-three patients(42 hips)were randomly divided into three groups.Group A(10 patients with 16 hips)received 2000 impulses of ESWT at 24 Kv to the affected hip.Group B(11 patients with 14 hips)and Group C(12 patients with 12 hips)received 4000 and 6000 impulses of ESWT respectively.The evaluations included clinical assessment,radiographs,MRI,microcirculation(Ktran)and plasma volume(Vp),and serum biomarkers(NO3,VEGF,BMP-2,osteocalcin,TNF-α,IL-6,substance P,CGRP,DKK-1 and IGF).Results: Significant differences of pain and Harris scores were noticed between Group A and C from 6 to 24 months after treatment(all P<0.05).Total hip arthroplasty was performed in 3 patients(4 hips)in Group A,but none in Groups B and C.Group C showed significant changes in serum angiogenesis,osteogenesis,anti-inflammation,pain threshold and tissue regeneration biomarkers within one month after treatment(all P<0.05).No significant changes in the infarction volume were noted in all groups(all P > 0.05).The post-treatment Ktran and Vp in the peri-necrotic areas of Group B and C were significantly greater than pre-treatment Ktran and Vp(both P<0.05).Discussion: Prior study reported ESWT is effective in early ONFH.However,the optional dosage is unknown.The results of the study revealed ESWT enhances angiogenesis at peri-necrotic areas of the femoral head that may in turn,improve subchondral bone remodeling and prevent femoral head collapse.Conclusions: High dosage ESWT is more effective in early stage ONFH.The systemic beneficial effects of ESWT may ultimately enhance microcirculation of perinecrotic areas and prevent femoral head collapse.