Читать книгу Shockwave Medicine - Группа авторов - Страница 24

In 2003, 4 healthcare workers including 3 women and 1 man with an average age of 26 years were affected by severe acute respiratory syndrome and were treated with a massive dose of corticosteroids that resulted in the development of early ONFH [21]. Those patients were treated with cocktail therapy that consisted of ESWT, HBO therapy, and alendronate. The practical applications of treatments were processed on 4 patients with 8 hips. First, each hip was treated with 6,000 impulses of shockwave at 0.62 mJ/mm² energy flux density (EFD) in a single session. Then, HBO was performed once a day, 5 times a week for a total of 100 sessions. Patients received alendronate sodium 70 mg per week for 1 year. All patients returned to work as health care providers, and none of the hips required surgery during the 4 years follow-up period.

Fig. 2. The right hip before and after treatment showed the reduction of bone marrow edema and no further collapse; lesions of the femoral heads on MRI.

Our study also compared the effect of ESWT with and without alendronate for treatment of ONFH [22]. Hsu et al. [23] randomly divided forty-eight patients with 60 hips into group A (25 patients with 30 hips) and group B (23 patients with 30 hips). Group A was treated with 6,000 impulses of ESWT at 0.62 mJ/mm² to the affected hip in a single session. Group B with ESWT received alendronate 70 mg per week for 1 year. Both groups showed significant improvement in pain and function of the hip (p < 0.001), but the differences between the 2 groups were nonsignificant (p = 0.400 and p = 0.313 respectively). In 2010, a comparison of cocktail therapy and ESWT alone was made in 63 patients (98 hips). The results showed that there was no difference between combined ESWT alendronate and HBO and ESWT alone to treat early ONFH. Therefore, the synergistic effects of ESWT, HBO, and alendronate treatments were not observed in short-term follow-up.