肌骨超声监测冲击波治疗早中期股骨头坏死血运变化

doi:10.3877/cma.j.issn.1674-134X.2026.03.004

中华关节外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (03) : 283 -290. doi: 10.3877/cma.j.issn.1674-134X.2026.03.004

临床论著

肌骨超声监测冲击波治疗早中期股骨头坏死血运变化

孙玺淳¹, 赵丽娟², 马青虎¹, 牛东生¹, 陈德胜¹, 梁钰琪¹, 马涛¹, 王聪¹, 程锁利¹^,^†(

)

¹　750002　银川，宁夏回族自治区人民医院关节外科（冲击波治疗中心）
²　750002　银川，宁夏回族自治区人民医院功能科心血管组

收稿日期:2025-06-27 出版日期:2026-06-01
通信作者: 程锁利
基金资助:
宁夏回族自治区重点研发计划(2022BEG03164); 自治区科技计划项目(2019BFG02012)

Musculoskeletal ultrasound monitoring of blood supply changes in shock wave therapy for early and mid-stage femoral head necrosis

Xichun Sun¹, Lijuan Zhao², Qinghu Ma¹, Dongsheng Niu¹, Desheng Chen¹, Yuqi Liang¹, Tao Ma¹, Cong Wang¹, Suoli Cheng¹^,^†()

¹ The Department of Joint Surgery (Shock Wave Therapy Center), Ningxia Hui Autonomous Region People’s Hospital, Yinchuan 750002, China
² The Cardiovascular Group of Functional Department, Ningxia Hui Autonomous Region People’s Hospital, Yinchuan 750002, China

Received:2025-06-27 Published:2026-06-01
Corresponding author: Suoli Cheng

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引用本文：

孙玺淳, 赵丽娟, 马青虎, 牛东生, 陈德胜, 梁钰琪, 马涛, 王聪, 程锁利. 肌骨超声监测冲击波治疗早中期股骨头坏死血运变化[J/OL]. 中华关节外科杂志(电子版), 2026, 20(03): 283-290.

Xichun Sun, Lijuan Zhao, Qinghu Ma, Dongsheng Niu, Desheng Chen, Yuqi Liang, Tao Ma, Cong Wang, Suoli Cheng. Musculoskeletal ultrasound monitoring of blood supply changes in shock wave therapy for early and mid-stage femoral head necrosis[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(03): 283-290.

目的

运用肌骨超声监测早中期股骨头坏死（ONFH）患者在体外冲击波治疗前后股骨头血运及微循环方面的影响，并采用T2加权像MRI验证，为冲击波治疗ONFH提供临床数据。

方法

宁夏回族自治区人民医院冲击波治疗门诊的60例明确诊断为ONFH的患者采用计算机生成的区组随机化方案随机均分为药物治疗组（药物组）、冲击波治疗组（冲击波组）。纳入标准：明确诊断为ONFH、国际骨循环协会（ARCO）分期Ⅰ～ⅢA期（塌陷＜2 mm）的患者。排除标准：凝血功能异常、治疗区域血栓、严重认知障碍、严重心律失常、妊娠、局部感染等。治疗前、冲击波治疗结束后（1周内）及治疗后3、6、9个月行VAS评分，分析组间差异及疗效观察。再将冲击波治疗组的患者，治疗前后行肌骨超声检查，记录患侧旋股内外侧支、外侧升支、横支和降支的血流阻力指数（RI）、血管充盈、收缩期峰值流速（PSV）等数据。采用MRI影像验证水肿消退及坏死带变化情况，明确治疗结果。统计学分析采用Shapiro-Wilk检验进行正态性检验，符合正态分布的计量资料以

x ¯

±s描述，组间比较采用单因素方差分析。

结果

两组患者治疗前基线资料差异无统计学意义（均为P＞0.05）。冲击波组与药物组治疗后疼痛均明显减轻，冲击波组起效虽慢但具有更长的疗效，冲击波组在后期镇痛效果明显优于药物组。治疗后6、9个月，冲击波组疼痛视觉模拟评分（VAS）（2.7±1.2、3.0±1.3）显著低于药物组（4.0±1.1、4.6±1.3），差异有统计学意义（t=4.12、4.68，均为P＜0.05）。冲击波组的肌骨超声检查提示，股骨头相关5条动脉治疗后3、6个月与治疗前相比，流速增加及血管阻力明显降低，提示冲击波治疗的患者股骨头的血运明显增加。冲击波组治疗后3、6个月肌骨超声显示，旋股内侧动脉、旋股外侧动脉及其分支的PSV较治疗前增加（均为P＜0.01），RI降低（均为P＜0.05），提示血运改善。治疗后6、12个月的MRI T2像检查提示：水肿带信号降低，而低信号带无明显变化，提示冲击波治疗后静脉淤滞现象好转或股骨头的坏死区无明显增加。

结论

体外冲击波对于ONFH的患者（ARCOⅠ、Ⅱ期和部分ⅢA期）具有明显的疗效，其缓解疼痛的效果优于或不低于药物治疗组的效果；冲击波能有效改善股骨头的血运，在相关的5条血管中，均能增加血流速度，减少血管阻力；MRI提示体外冲击波对于ONFH的患者（ARCOⅠ～Ⅱ期）具有稳定病情，延缓手术治疗的时间。冲击波治疗股骨头坏死（ARCOⅠ、Ⅱ期）具有良好的临床效果，值得推广。

关键词: 体外冲击波疗法, 股骨头坏死, 超声成像

Objective

To monitor the impact of extracorporeal shock wave therapy on the blood supply and microcirculation of the femoral head in patients with early-to-mid-stage osteonecrosis of the femoral head (ONFH) using musculoskeletal ultrasound and T2-weighted MRI for verification, so as to provide clinical data for the treatment of ONFH with shock waves.

Methods

Sixty patients diagnosed with osteonecrosis of the femoral head (ONFH) (ARCO stageⅠto Ⅲ A) in Shock Wave Therapy Center of Ningxia Hui Autonomous Region People’s Hospital were randomly divided into the medication treatment group (medication group) and the shockwave treatment group (shockwave group) using a computer-generated block randomization scheme. Inclusion criteria: patients diagnosed with ONFH, Association Research Circulation Osseous (ARCO) stages Ⅰto Ⅲ A (collapse <2 mm). Exclusion criteria: abnormal coagulation function, thrombosis in the treatment area, severe cognitive impairment, severe arrhythmia, pregnancy, local infection, etc. VAS score was assessed before treatment, after shockwave treatment (within one week), and at three, six and nine months after treatment to analyze inter-group differences and observe treatment efficacy. Musculoskeletal ultrasound examinations were performed in the shockwave group before and after treatment to record data such as blood flow resistance index (RI), vascular filling, and peak systolic velocity (PSV) of the medial and lateral circumflex femoral arteries, lateral femoral ascending branch, transverse branch, and descending branch on the affected side. MRI was used to verify the regression of edema and changes in the necrotic zone, confirming the treatment outcome. Shapiro-Wilk test was performed to evaluate normality. Measurement data were described as

x ¯

±s, and one-way analysis of variance was applied.

Results

There was no statistically significant difference in baseline data between the two groups before treatment (all P>0.05). Both the shockwave group and the conventional medication group showed significant pain relief after treatment. Although the onset of action in the shockwave group was slower, it had a longer duration of efficacy. The analgesic effect of the shockwave group was significantly better than that of the medication group in the later stages. Six and nine months after treatment, VAS scores in the shockwave group (2.7±1.2, 3.0±1.3) were lower than those in the medication group (4.0±1.1, 4.6±1.3), with statistically significant differences (t=4.12, 4.68, both P<0.05). Three and six months after treatment, musculoskeletal ultrasound examination of the five arteries related to the femoral head showed increased flow velocity and decreased vascular resistance, indicating a significant increase in blood flow in the femoral head of patients treated with shockwaves. Musculoskeletal ultrasound at three and six months after treatment in the shockwave treatment group showed a significant increase in PSV of the medial circumflex femoral artery, lateral circumflex femoral artery, and their branches compared to before treatment (all P<0.01), with a significant decrease in RI (all P<0.05), indicating improved blood flow. MRI T2-weighted imaging in six and 12 months after treatment showed reduced edema zone signals, with no significant changes in the hypointense zone, suggesting improvement in venous stasis or no significant increase in the necrotic area of the femoral head after shockwave treatment.

Conclusions

Extracorporeal shock wave therapy has significant therapeutic effects on patients with ONFH in ARCO stagesⅠ, Ⅱ, and some cases of stage Ⅲ A. The pain relief effect is superior to or at least comparable to that of the drug treatment group. Shock wave therapy can effectively improve the blood supply of the femoral head, increasing blood flow velocity and reducing vascular resistance in all five relevant vessels. MRI suggests that extracorporeal shock wave therapy stabilizes the condition of patients with ONFH in ARCO stagesⅠand Ⅱ, delaying the need for surgical intervention. Shock wave therapy for the femoral head in ARCO stagesⅠand Ⅱ has demonstrated good clinical outcomes and is worth promoting.

Key words: Extracorporeal shock wave, Femur head necrosis, Ultrasonograrhy

图1 股骨近端体表投影点选择注：患者取平卧位，选取股骨近端体表投影3～5点，股骨头点，股骨颈点，大粗隆点，股骨颈两侧点及旋股内外侧动脉附近点

Figure 1 Selection of body surface projection points of the proximal femur Note: The patient lies in a supine position, and three to five sites are chosen on the body surface that are projections of the proximal femur, including the femoral head, femoral neck, greater trochanter, bilateral sties of the femoral neck, and the sites near the medial and lateral circumflex femoral arteries

图2 右侧股骨头供血动脉解剖及肌骨超声监测部位示意图。图A为右股骨旋股内外侧动脉造影，箭头示旋股外侧动脉的三个分支（升支、横支、降支）；图B为肌骨超声图，显现管径、流速及阻力指数

Figure 2 Schematic diagram of the anatomy of the blood supply artery of the right femoral head and the monitoring sites for musculoskeletal ultrasound. A is angiography of the medial and lateral circumflex femoral arteries, and the three branches of the lateral circumflex femoral artery (ascending branch, transverse branch, descending branch); B is musculoskeletal ultrasound image showing the caliber, flow velocity, and resistance index

表1 两组患者一般资料比较

Table 1 Baseline comparison among each group

分组Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	女性占比 Female ratio（%）	BMI ［kg/m²，（ $x ¯$ ±s）］	病程［月，（ $x ¯$ ±s）］ Course of disease（month）	WOMAC评分（ $x ¯$ ±s）	VAS评分（ $x ¯$ ±s）
冲击波组 Shockwave group	30	59.3±9.8	33.7	25.8±1.9	16.7±7.2	83.7±9.1	4.8±1.5
药物组 Medication group	30	59.9±9.0	40.0	25.4±1.6	16.2±7.3	78.9±9.0	5.0±1.6
统计值 Statistical values		t=0.24	χ²=0.29	t=0.86	t=0.26	t=1.98	t=0.42
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05

表1 两组患者一般资料比较

Table 1 Baseline comparison among each group

分组Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	女性占比 Female ratio（%）	BMI ［kg/m²，（ $x ¯$ ±s）］	病程［月，（ $x ¯$ ±s）］ Course of disease（month）	WOMAC评分（ $x ¯$ ±s）	VAS评分（ $x ¯$ ±s）
冲击波组 Shockwave group	30	59.3±9.8	33.7	25.8±1.9	16.7±7.2	83.7±9.1	4.8±1.5
药物组 Medication group	30	59.9±9.0	40.0	25.4±1.6	16.2±7.3	78.9±9.0	5.0±1.6
统计值 Statistical values		t=0.24	χ²=0.29	t=0.86	t=0.26	t=1.98	t=0.42
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05

表2 不同时间点两组患者VAS评分比较（

x ¯

±s）

Table 2 Comparison of VAS scores between the two groups at different time points

分组 Groups	例数 Number of cases	治疗前 Before treatment	治疗结束后 After treatment	结束后3个月 Three months after treatment	结束后6个月 Six months after treatment	结束后9个月Nine months after treatment
冲击波组 Shockwave group	30	4.8±1.5	2.4±1.0	2.4±1.2	2.7±1.2	3.0±1.3
药物组 Medication group	30	5.0±1.7	2.4±1.1	2.4±1.1	4.0±1.1	4.6±1.3
t值		0.42	0.11	0.10	4.12	4.68
P值		＞0.05	＞0.05	0.03	0.012	0.017

表2 不同时间点两组患者VAS评分比较（

x ¯

±s）

Table 2 Comparison of VAS scores between the two groups at different time points

分组 Groups	例数 Number of cases	治疗前 Before treatment	治疗结束后 After treatment	结束后3个月 Three months after treatment	结束后6个月 Six months after treatment	结束后9个月Nine months after treatment
冲击波组 Shockwave group	30	4.8±1.5	2.4±1.0	2.4±1.2	2.7±1.2	3.0±1.3
药物组 Medication group	30	5.0±1.7	2.4±1.1	2.4±1.1	4.0±1.1	4.6±1.3
t值		0.42	0.11	0.10	4.12	4.68
P值		＞0.05	＞0.05	0.03	0.012	0.017

表3 冲击波治疗患者的肌骨超声检查结果［n=30，（

x ¯

±s）］

Table 3 The examination results of bone ultrasound of patients undergoing shock wave therapy

	时间点 Time points	血管内径（mm） Lumen diameter	流速（cm/s） Peak systolic velocity	阻力指数 Resistive index
旋股内侧动脉 Medial circumflex femoral artery	治疗前 Before treatment	2.700±0.300	35.000±0.400	0.810±0.200
	治疗结束后3个月 Three months after treatment	2.900±0.300	95.200±0.300	1.000±0.200
	治疗结束后6个月 Six months after treatment	2.900±0.800	59.400±0.500	1.000±0.300
	F值	1.23	12.34	9.87
	P值	＞0.05	0.002	0.007
	时间点 Time points	血管内径（mm） Lumen diameter	流速（cm/s） Peak systolic velocity	阻力指数 Resistive index
旋股外侧动脉Lateral circumflex femoral artery	治疗前 Before treatment	3.300±0.500	0.310±0.100	0.820±0.300
	治疗结束后3个月 Three months after treatment	3.300±0.900	66.000±3.000	1.000±0.300
	治疗结束后6个月 Six months after treatment	3.300±1.000	66.000±3.300	1.000±0.500
	F值	0.89	10.56	8.92
	P值	＞0.05	0.004	0.011
	时间点 Time points	血管内径（mm） Lumen diameter	流速（cm/s） Peak systolic velocity	阻力指数 Resistive index
旋股外侧动脉升支Ascending branch of the lateral circumflex femoral artery	治疗前 Before treatment	2.100±0.100	0.200±0.020	0.800±0.300
	治疗结束后3个月 Three months after treatment	2.400±0.200	59.000±0.600	0.780±0.200
	治疗结束后6个月 Six months after treatment	2.400±0.500	47.000±0.500	1.000±0.100
	F值	2.45	15.78	11.34
	P值	＞0.05	＜0.001	0.003
	时间点 Time points	血管内径（mm） Lumen diameter	流速 Peak Systolic Velocity	阻力指数 Resistive Index
旋股外侧动脉横支Lateral circumflex femoral artery transverse branch	治疗前 Before treatment	2.500±0.200	0.250±0.040	0.770±0.100
	治疗结束后3个月 Three months after treatment	2.500±0.500	39.900±0.090	1.000±0.200
	治疗结束后6个月 Six months after treatment	2.500±0.700	41.000±0.800	1.000±0.100
	F值	1.01	14.23	12.01
	P值	＞0.05	＜0.001	0.002
	时间点 Time points	血管内径（mm） Lumen diameter	流速（cm/s） Peak systolic velocity	阻力指数 Resistive index
旋股外侧动脉降支Descending branch of lateral circumflex femoral artery	治疗前 Before treatment	3.000±0.600	0.330±0.100	0.790±0.200
	治疗结束后3个月 Three months after treatment	2.900±0.800	64.300±0.300	1.000±0.400
	治疗结束后6个月 Six months after treatment	2.900±1.000	61.000±0.500	1.000±0.300
	F值	1.56	13.67	10.23
	P值	＞0.05	0.001	0.005

表3 冲击波治疗患者的肌骨超声检查结果［n=30，（

x ¯

±s）］

Table 3 The examination results of bone ultrasound of patients undergoing shock wave therapy

	时间点 Time points	血管内径（mm） Lumen diameter	流速（cm/s） Peak systolic velocity	阻力指数 Resistive index
旋股内侧动脉 Medial circumflex femoral artery	治疗前 Before treatment	2.700±0.300	35.000±0.400	0.810±0.200
	治疗结束后3个月 Three months after treatment	2.900±0.300	95.200±0.300	1.000±0.200
	治疗结束后6个月 Six months after treatment	2.900±0.800	59.400±0.500	1.000±0.300
	F值	1.23	12.34	9.87
	P值	＞0.05	0.002	0.007
	时间点 Time points	血管内径（mm） Lumen diameter	流速（cm/s） Peak systolic velocity	阻力指数 Resistive index
旋股外侧动脉Lateral circumflex femoral artery	治疗前 Before treatment	3.300±0.500	0.310±0.100	0.820±0.300
	治疗结束后3个月 Three months after treatment	3.300±0.900	66.000±3.000	1.000±0.300
	治疗结束后6个月 Six months after treatment	3.300±1.000	66.000±3.300	1.000±0.500
	F值	0.89	10.56	8.92
	P值	＞0.05	0.004	0.011
	时间点 Time points	血管内径（mm） Lumen diameter	流速（cm/s） Peak systolic velocity	阻力指数 Resistive index
旋股外侧动脉升支Ascending branch of the lateral circumflex femoral artery	治疗前 Before treatment	2.100±0.100	0.200±0.020	0.800±0.300
	治疗结束后3个月 Three months after treatment	2.400±0.200	59.000±0.600	0.780±0.200
	治疗结束后6个月 Six months after treatment	2.400±0.500	47.000±0.500	1.000±0.100
	F值	2.45	15.78	11.34
	P值	＞0.05	＜0.001	0.003
	时间点 Time points	血管内径（mm） Lumen diameter	流速 Peak Systolic Velocity	阻力指数 Resistive Index
旋股外侧动脉横支Lateral circumflex femoral artery transverse branch	治疗前 Before treatment	2.500±0.200	0.250±0.040	0.770±0.100
	治疗结束后3个月 Three months after treatment	2.500±0.500	39.900±0.090	1.000±0.200
	治疗结束后6个月 Six months after treatment	2.500±0.700	41.000±0.800	1.000±0.100
	F值	1.01	14.23	12.01
	P值	＞0.05	＜0.001	0.002
	时间点 Time points	血管内径（mm） Lumen diameter	流速（cm/s） Peak systolic velocity	阻力指数 Resistive index
旋股外侧动脉降支Descending branch of lateral circumflex femoral artery	治疗前 Before treatment	3.000±0.600	0.330±0.100	0.790±0.200
	治疗结束后3个月 Three months after treatment	2.900±0.800	64.300±0.300	1.000±0.400
	治疗结束后6个月 Six months after treatment	2.900±1.000	61.000±0.500	1.000±0.300
	F值	1.56	13.67	10.23
	P值	＞0.05	0.001	0.005

图3 冲击波治疗组ONFH（股骨头坏死）患者治疗后双髋关节影像。A为复查双侧髋关节正位X线片，未见右侧股骨头关节面塌陷；B为治疗结束后3个月双侧髋关节MRI冠状位T2加权像，示右侧股骨头水肿带信号减低、范围缩小；C为治疗结束后6个月双侧髋关节MRI冠状位T2加权像，示右侧股骨头水肿带部分消退，坏死区范围稳定无扩大

Figure 3 Bilateral hips images of the patient with ONFH (osteonecrosis of the femoral head) in the shockwave therapy group after treatment. A is X-ray image of pelvis at anteroposterior position, showing no articular surface collapse; B is coronal T2-weighted MR image at three months after the treatment for right hip, showing reduced signal intensity and narrowed range of the edema zone; C is coronal T2-weighted MR image at six months after the treatment for right hip, showing partial regression of the edema zone and stable necrotic area without expansion

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Musculoskeletal ultrasound monitoring of blood supply changes in shock wave therapy for early and mid-stage femoral head necrosis

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Musculoskeletal ultrasound monitoring of blood supply changes in shock wave therapy for early and mid-stage femoral head necrosis