| Background: As a common and frequently occurring disease in the Department of orthopedics, the incidence rate of the necrosis of the femoral head(ONFH) is increasing year by year, and the incidence of the disease is at the age of 30 to 50 years old and the patients is younger and younger. According to the latest reports, there are about 150 to 200 thousands new patients every year, and about 5 ~ 7 million patients are waiting for the treatment in China. Extracorporeal shock wave therapy as a kind of non-itrusive treatment, has certain therapeutic effect for ONFH. The MRI can evaluate the necrosis area of ONFH from the different fault plane, can not get the necrosis volume precisely, and the scanning plane is not consistent before and after treatment.The traditional shock wave therapy use lateral focus, the therapeutic effect is not very ideal because of the deeper penetrate distance and acetabulum blocking. So it seems urgent to find a measurement method of necrosis volume of femoral head and made a personalized shockwave treatments scheme.Objective: To evaluate the ESWT treatment effect for ONFH through finite element analysis software for MRI 3d reconstruction and measurement of necrotic volume. And according to the 3d reconstruction model to set up new ONFH parting, provide theoretical support and guidance for clinical ESWT treatment for ONFH.Methods: We selected the patients with osteonecrosis of the femoral head treated in the outpatient department between March and September 2014, all the patients made the double hip side X ray and thin layer MRI scans, contact the Institute Hospital MRI experienced technicians and set a particular scan slice thickness and slice gap and other related parameters needed in this study. According to the MRI results combined with international circulation research will avascular necrosis of the femoral head in stage(Arco staging criteria for determining the I and II 56 patients(87 hips) which were randomly divided into experimental group(personalized extracorporeal shock wave treatment group) and control group(traditional shock wave therapy group). We imported the original data(DICOM format hip coronal T1 weighted like MRI images) of patients with bilateral hip MRI scanning into materialise’s interactive medical image control system software(mimics), the software can through image segmentation, visualization, registration and other functions combined with region of interest to preliminary reconstruction of three-dimensional,by, according to 3D getting in stage1. Using the magic stick of Adobe Photoshop CC professional image processing software features delineated necrotic area and access to the corresponding image. And finally use the North Carolina triangle zone design Geomagic modeling software to get the final stock bone necrosis 3D model in STL format, according to our department with previous Japanese bone necrosis of the JIC typing and the Sino Japanese Friendship Hospital avascular necrosis of the femoral head type formulation of avascular necrosis of the femoral head six-part method in the magnetic model of three-dimensional reconstruction of three-dimensional partitioning. Patients in the individualized treatment group took the supine position, made the treatment head reflector water sac is located in front of the femoral head, labeled the important nerves and blood vessels on the surface before and during treatment by the treatment experience of doctors to avoid adverse effect, determined the individualized treatment plan according to the patients with necrosis type. The flow density was adjusted to 0.16 ~ 0.22 m J/mm2, 1500 to 2000 pulses every time, every other day a treatment, 4 times for a course of treatment, the total impact 6000 ~ 8000 pulses. The control group using conventional lateral focused extracorporeal shock wave therapy, parameters such as individualized treatment group. Bilateral hip MRI slices and positive side and breaststroke radiographs were made before treatment and after treatment for 6 months, 12 months and 18 months. The patients were followed up for pain score(VAS) and Harris hip score and compared necrosis volume before treatment and after treatment for 6,12 and 18 months. The data was represented by mean plus or minus standard deviation(x + s) and analyzed by SPSS 13.0.Results: The VAS pain score and Harris score were significantly improved after 6,12 and 18 months after extracorporeal shock wave therapy both in the test group and the control group, which was statistically significant(P<0.001). The necrosis volume at 18 months after treatment was statistically significant(P<0.001), but in 6 months(P=0.07) and 12 months(P=0.06) was not statistically significant in the control group. The necrosis volume at 12months(P=0.008) and 18 months(P<0.001) after treatment also have statistical significance, but 6 months(P=0.06) was not statistically significant in the individualized treatment group. The VAS and Harris hip score before treatment and after treatment follow-up each node had no statistical significance(P > 0.05) in the individualized treatment group and the control group, necrosis volume in the before treatment and 6 months and 12 months after the treatment are no statistical significance(P > 0.05), but 18 months after shockwave treatment is statistically significant(P < 0.001).Conclusion: After three dimensional reconstruction of the MRI original data of the patients, which can accurately locate the area and the range of the femoral head of necrosis, and there was a trend of the size of the necrosis volume decreasing by the follow up of the MRI three dimensional reconstruction. Extracorporeal shock wave therapy as a conservative treatment method, especially the study and formulate individualized treatment plan, for the early stage femoral head necrosis in patients with hip pain has significantly improved, can slow disease process and improve life quality of the patients. |
PDF Full Text Request