Objective: To evaluated the outcome of prevention and treatment for glucocorticoid-induced osteonecrosis of femoral head with anticoagulant and vasodilator drugs. Methods: A prospective, randomized, double-blind study was performed. From August 2003 to August 2006, 58 patients with large amounts of hormone therapy in the Zhongshan Hospital Affiliated Dalian University were enrolled and randomly assigned to the control group (placebo) or preventive group (anticoagulant and vasodilator drugs). And we prospectively analyzed the clinical outcomes of 24 patients with glucocorticoid-induced osteonecrosis of femoral head early stage (treatment group)treated by anticoagulant and vasodilator drugsat the same time. Disease incidence rate and progression were evaluated by radiography and magnetic resonance imaging (MRI), Follow-up of patients with femoral head survival curve was drawn. The Harris Hip Score and the Short Form 36 health survey were used to rate hip function and quality of life, respectively. Results: Thus, a total of 80 patients were assessed in this study, 24 cases in control group[follow up from 7.5 to 13.0(10.7±1.6)years], 22 cases in preventive group and 24 cases in treatment group. There was significant difference in theincidence rate of Osteonecrosis of femoral head, survive rate of femoral head and HHS score between the control groupand preventive group(41.7% vs 13.6%, 66.7% vs 70.8% , P<0.01). Conclusion: Anticoagulant and vasodilator drugs could effect on preventing theglucocorticoid-induced osteonecrosis of femoral head, reducing disease progression, or improving life quality.
目的： 评价抗凝联合扩血管药物预防和治疗激素性股骨头坏死的临床效果。 方法： 2003年8月至2006年8月，大连大学附属中山医院骨科采用前瞻性随机双盲对照研究方法收集期间在大连大学附属中山医院应用大量激素治疗患者56例，数字表法随机分成对照组(安慰剂28例)和预防组(抗凝联合扩血管药物28例)；同时对24例确诊为激素性股骨头坏死早期患者(治疗组)应用抗凝联合扩血管药物治疗的疗效进行前瞻性分析。通过影像学评价股骨头坏死发病率以及病情进展，绘制随访患者股骨头生存曲线，观察干预前后患者HHS评分及SF36健康调查评分。 结果： 对照组随访24例，随访时间为7.5～13.0(10.7±1.6)年；预防组随访22例，随访时间为10.0～13.0(11.5±0.8)年。对照组发生股骨头坏死为10例(41.7%)，预防组发生股骨头坏死3例(13.6%)，对照组股骨头坏死发生率显著高于对照组(P<0.01)。治疗组病例全部获得随访，随访时间(10.4±2.4)年，股骨头坏死塌陷7例(29.2%)。预防组股骨头生存率为100.0%，对照组股骨头生存率为66.7%，预防组股骨头生存率显著高于对照组(P<0.01)，治疗组股骨头生存率为70.8%。对照组随访后Harris髋关节评分(HHS)显著低于预防组HHS；预防组随访后SF36生理职能评分(SF)显著高于对照组，预防组随访后SF躯体疼痛评分显著高于对照组。 结论： 抗凝联合扩血管药物对激素性股骨头坏死的预防和治疗具有明显作用。内科医师在应用激素进行治疗的同时预防性应用抗凝联合扩血管药物有助于降低激素性股骨头坏死的发生率。.
Keywords: Anticoagulant drug; Disease prevention; Drug treatment; Glucocorticoid-induced osteonecrosis of femoral head; Vasodilator drug.