摘要目的 探讨高压氧(hyperbaric oxygen,HBO)治疗对于激素性股骨头坏死(steroid-induced necrosis of the femoral head,SNFH)中期(ARCOⅡa～Ⅲa期)的患者是否具有临床疗效.方法 选取2012年10月至2017年1月于海军总医院门诊及住院临床确诊为SNFH(ARCOⅡa～Ⅲa期)的患者53例(20例被排除在外)进行前瞻性随机交叉试验.所有参与者入组前进行Harris评分及MRI影像学评估(股骨头坏死指数、股骨头坏死面积、骨髓水肿评分).入组后患者被随机分配到实验组或交叉组.实验组患者在入组前和60次HBO治疗后(3个月)进行第2次评估,包括Harris评分、MRI影像学评估及髋痛缓解率.交叉组患者在对照干预(3个月)以及HBO治疗后(6个月)分别进行第2次和第3次评估,包括Harris评分、MRI影像学评估及髋痛缓解率.结果 实验组或交叉组在HBO治疗后Harris评分均提高[实验组HBO治疗前:(68.4±8.2)分,HBO治疗后:(76.2±3.6)分;交叉组HBO治疗前:(67.5±4.1)分,HBO治疗后:(76.1±3.9)分](P＜0.05),骨髓水肿评分均减轻(P＜0.05),而交叉组在对照期前后Harris评分、股骨头坏死指数、股骨头坏死面积、骨髓水肿评分均无改善.实验组或交叉组在HBO治疗后的髋痛缓解率与交叉组在对照干预前后髋痛缓解率的差异有统计学意义(P＜0.05).结论 HBO治疗可以改善SNFH中期(ARCOⅡa-Ⅲa期)患者Harris评分以及MRI影像学骨髓水肿评分,减轻患者髋痛症状.

abstractsObjective To investigate the clinical efficacy of hyperbaric oxygen (HBO) therapy on steroid-induced necrosis of the femoral head (SNFH) at the stages of ARCO Ⅱ a and Ⅲ a.Methods A prospective,randomized,controlled trial was performed in 53 patients (20 were excluded),who were conformed to have SNFH at the stages of ARCOⅡa and Ⅲa through clinical medical care and or hospitalization.Before enrollment,the Harris and MRI scores (the indexes of femoral head necrosis,the areas of necrosis and bone marrow edema) were evaluated in all the subjects.After enrollment,the patients were randomly assigned to the experimental group or the cross group.Before enrollment and after 60 sessions of HBO therapy,the patients in the experimental group were evaluated the second time,which included Harris/MRI scores and relief rate of coxalgia.After 3-month intervention and 6-month HBO therapy,the patients in the cross group had evaluations the second and third times,which also included Harris/MRI scores and relief rate of coxalgia.Results Following HBO therapy,the Harris scores of either the experimental group or the cross group all increased,and the bone marrow edema scores decreased [Before HBO therapy in the experimental group:(68.4 ± 8.2) scores,after HBO thercopy:(76.2 ± 3.6) scores;Before HBO therapy in the cross group:(67.5 ± 4.1) scores;after HBO therapy:(76.1 ± 3.9)scores] (P ＜ 0.05),while the Harris scores,the area of femoral head necrosis and the bone marrow edema scores all failed to improve in the patients of the cross group (P ＜ 0.05).Following HBO therapy,statistical significance could be noted in the relief rate of coxalgia in both groups (P ＜ 0.05).Conclusions HBO therapy could improve Harris and MRI scores of the patients at middle stage of steroid-induced necrosis of the femoral head,and could also alleviate coxalgia symptoms of the patients with SNFH.