Effects Of Shock Wave Therapy Of Based On Necrotic Volume And Spatial Location Vs Celecoxib On Hip Pain Caused By Femoral Head Necrosis

Background: Osteonecrosis of the femoral head(ONFH)is an ischemic necrotic disease caused by trauma,drinking,obesity,smoking and the use of glucocorticoids.With the aggravation of ischemia and the death of bone cells and bone tissue,the structure of the femoral head will gradually change and then collapse,even lead to disability.At present,ONFH mostly occurs in young and active patients,so clinical analgesia and anti-inflammation,improve function for the purpose of symptomatic hip preservation treatment,in order to ensure the quality of life of patients.As a non-steroidal anti-inflammatory drug,celecoxib has a good analgesic effect on pain caused by ONFH,and can selectively inhibit cyclooxygenase-2,thus inhibiting local tissue inflammation and pain caused by prostaglandin expression,but its long-term use is often accompanied by serious adverse reactions.Aim:(1)The MRI-3D reconstruction technique of necrotic area was used to accurately determine the spatial location and volume of ONFH,so that the shock wave therapy energy was accurately coupled in the necrotic area and its periphery,to form personalized ESWT,and then to study the effect of this therapy on hip function in patients with ONFH.(2)To evaluate the efficacy and safety of ESWT based on necrotic area MRI-3D zone in short-term improvement of hip pain and functional limitation caused by ONFH.(3)Celecoxib was used as the reference standard to compare the difference between the two treatments in improving hip pain and functional limitation caused by ONFH.Methods: 78 patients with hip pain and functional limitation diagnosed as ONFH(ARCO stage I-IV)in our hospital from June 2021 to August 2022 were randomly divided into experimental group(n = 39)and control group(n = 39).The experimental group is the personalized ESWT group based on MRI-3D partition: the original MRI data of the patients’ bilateral hips were imported into the Mimics Research21.0 software,and the necrotic area was calibrated.The three-dimensional model of the patient’s femoral head and its necrotic area were obtained by software analysis.After the reconstruction was completed,the whole femoral head was divided into 6 zones according to the zoning method developed by our department combined with JIC typing of Japan Osteonecrosis Research Association and ONFH typing of China-Japan Friendship Hospital.Each zone corresponding to personalized posture was treated with personalized ESWT.The control group was treated with oral celecoxib and alendronate sodium.After treatment,visual analogue score(VAS),Harris score,osteoarthritis index(WOMAC)of western Ontario and Mc Master University of Canada were used to analyze the curative effect,and three-dimensional reconstruction technique was used to measure the volume of necrotic area.Among them,the Harris score of the second week after treatment was taken as the main evaluation index(10 points more effective than that before treatment).The difference in the effective rate between the experimental group and the control group was obtained by comparing the effective rate between the experimental group and the control group.All patients were followed up for 8 weeks and MRI and X-ray were taken and compared before treatment at the third month after treatment.Results In the experimental group,the Harris score,VAS score and WOMAC score were significantly improved on the 1st day,2nd week,4th week and 8th week after treatment.In the control group,VAS score and WOMAC score were significantly improved on the 1st day,2nd week,4th week and 8th week after treatment.However,the Harris score only showed statistical difference in the second week after treatment compared with that before treatment.(P < 0.05)At 3 months after treatment,the X-ray and MRI images of the two groups had no significant change compared with those before treatment,and the necrotic volume had no significant change compared with that before treatment.(P > 0.05)in the second week,the effective rate of the experimental group was 69% > that of the control group was 51%.The 95%confidence interval of the difference between the two groups was [-4.56%,40.56%]and-4.56% >-10%(non-inferiority value).Conclusion: Personalized ESWT based on MRI-3D partition can improve hip pain and functional limitation caused by ONFH in a short time,delay the progression of ONFH,and its effective rate is not inferior to that of celecoxib in improving hip pain.