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A 12-year follow-up study of combined treatment of post-severe acute respiratory syndrome patients with femoral head necrosis

Identifieur interne : 000748 ( Ncbi/Merge ); précédent : 000747; suivant : 000749

A 12-year follow-up study of combined treatment of post-severe acute respiratory syndrome patients with femoral head necrosis

Auteurs : Tiansheng Liu ; Jinchao Ma ; Bin Su [République populaire de Chine] ; Hao Wang ; Qi Wang ; Xinlong Ma

Source :

RBID : PMC:5656358

Abstract

Objective

To investigate the long-term efficacy of a combination treatment of alendronate, extracorporeal shock and hyperbaric oxygen for osteonecrosis of the femoral head (ONFH) of post-severe acute respiratory syndrome (SARS) patients.

Patients and methods

The retrospective study was performed including a total of 37 post-SARS ONFH patients (66 hip joints) in the Department of Orthopedics of the General Hospital of Tianjin Medical University between November 2003 and November 2015, consisting of 6 males (11 hip joints) and 31 females (55 hip joints), with age between 19 and 47 years (average 29.9 years). Visual analog scale (VAS) score, Harris score and Association Research Circulation Osseous (ARCO) stage of imaging examination were compared among those before treatment, and at 1, 3, 6, 9 and 12 years after treatment. Paired t-test was used for statistical analysis of VAS and Harris score before and after treatment. Difference of effective rate on all stages was analyzed with Chi-square test.

Results

With 12-year follow-up, significant improvements on VAS (6.81 of pre-treatment vs 3.94 of 12-year post-treatment) and Harris score (74.54 of pre-treatment vs 80.14 of 12-year post-treatment) were observed (all p<0.05). Effective rate showed statistical significance among three stages of ARCO (p<0.05). The combined treatment showed different efficacies on different ARCO stages; the best was on ARCO Phase I.

Conclusion

The combined treatment may delay or discontinue the development of ONFH in post-SARS patients.


Url:
DOI: 10.2147/TCRM.S140694
PubMed: 29089773
PubMed Central: 5656358

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PMC:5656358

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<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Liu</surname>
<given-names>Tiansheng</given-names>
</name>
<xref ref-type="aff" rid="af1-tcrm-13-1449">1</xref>
<xref ref-type="aff" rid="af2-tcrm-13-1449">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ma</surname>
<given-names>Jinchao</given-names>
</name>
<xref ref-type="aff" rid="af3-tcrm-13-1449">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Su</surname>
<given-names>Bin</given-names>
</name>
<xref ref-type="aff" rid="af4-tcrm-13-1449">4</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Wang</surname>
<given-names>Hao</given-names>
</name>
<xref ref-type="aff" rid="af3-tcrm-13-1449">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Wang</surname>
<given-names>Qi</given-names>
</name>
<xref ref-type="aff" rid="af3-tcrm-13-1449">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ma</surname>
<given-names>Xinlong</given-names>
</name>
<xref ref-type="aff" rid="af1-tcrm-13-1449">1</xref>
<xref ref-type="aff" rid="af2-tcrm-13-1449">2</xref>
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</contrib-group>
<aff id="af1-tcrm-13-1449">
<label>1</label>
Department of Orthopaedic Surgery, The General Hospital of Tianjin Medical University</aff>
<aff id="af2-tcrm-13-1449">
<label>2</label>
Department of Orthopaedic Surgery, Tianjin Hospital</aff>
<aff id="af3-tcrm-13-1449">
<label>3</label>
Department of Orthopaedic Surgery</aff>
<aff id="af4-tcrm-13-1449">
<label>4</label>
Department of Pneumology, the Affiliated Hospital of Logistics University of PAP, Tianjin, People’s Republic of China</aff>
<author-notes>
<corresp id="c1-tcrm-13-1449">Correspondence: Xinlong Ma, Department of Orthopaedic Surgery, The General Hospital of Tianjin Medical University, No 154 Anshandao, Heping District, Tianjin 300000, People’s Republic of China, Tel +86 22 2833 2917, Email
<email>landslands2003@sina.com</email>
</corresp>
</author-notes>
<pub-date pub-type="collection">
<year>2017</year>
</pub-date>
<pub-date pub-type="epub">
<day>19</day>
<month>10</month>
<year>2017</year>
</pub-date>
<volume>13</volume>
<fpage>1449</fpage>
<lpage>1454</lpage>
<permissions>
<copyright-statement>© 2017 Liu et al. This work is published and licensed by Dove Medical Press Limited</copyright-statement>
<copyright-year>2017</copyright-year>
<license>
<license-p>The full terms of this license are available at
<ext-link ext-link-type="uri" xlink:href="https://www.dovepress.com/terms.php">https://www.dovepress.com/terms.php</ext-link>
and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>
). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p>
</license>
</permissions>
<abstract>
<sec>
<title>Objective</title>
<p>To investigate the long-term efficacy of a combination treatment of alendronate, extracorporeal shock and hyperbaric oxygen for osteonecrosis of the femoral head (ONFH) of post-severe acute respiratory syndrome (SARS) patients.</p>
</sec>
<sec>
<title>Patients and methods</title>
<p>The retrospective study was performed including a total of 37 post-SARS ONFH patients (66 hip joints) in the Department of Orthopedics of the General Hospital of Tianjin Medical University between November 2003 and November 2015, consisting of 6 males (11 hip joints) and 31 females (55 hip joints), with age between 19 and 47 years (average 29.9 years). Visual analog scale (VAS) score, Harris score and Association Research Circulation Osseous (ARCO) stage of imaging examination were compared among those before treatment, and at 1, 3, 6, 9 and 12 years after treatment. Paired
<italic>t</italic>
-test was used for statistical analysis of VAS and Harris score before and after treatment. Difference of effective rate on all stages was analyzed with Chi-square test.</p>
</sec>
<sec>
<title>Results</title>
<p>With 12-year follow-up, significant improvements on VAS (6.81 of pre-treatment vs 3.94 of 12-year post-treatment) and Harris score (74.54 of pre-treatment vs 80.14 of 12-year post-treatment) were observed (all
<italic>p</italic>
<0.05). Effective rate showed statistical significance among three stages of ARCO (
<italic>p</italic>
<0.05). The combined treatment showed different efficacies on different ARCO stages; the best was on ARCO Phase I.</p>
</sec>
<sec>
<title>Conclusion</title>
<p>The combined treatment may delay or discontinue the development of ONFH in post-SARS patients.</p>
</sec>
</abstract>
<kwd-group>
<title>Keywords</title>
<kwd>SARS</kwd>
<kwd>osteonecrosis of the femoral head</kwd>
<kwd>alendronate</kwd>
<kwd>extracorporeal shock wave</kwd>
<kwd>hyperbaric oxygen</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group>
<fig id="f1-tcrm-13-1449" position="float">
<label>Figure 1</label>
<caption>
<p>MRI images show the differences of femoral hip cystic lesions pre- and post-treatment from a 47-year-old male patient with bilateral femoral hip cystic lesions.</p>
<p>
<bold>Notes: A</bold>
: pre-treatment;
<bold>B</bold>
: 1 year after treatment;
<bold>C</bold>
: 3 years after treatment;
<bold>D</bold>
: 6 years after treatment;
<bold>E</bold>
: 9 years after treatment and
<bold>F</bold>
: 12 years after treatment. Red arrows point out the cystic lesions.</p>
<p>
<bold>Abbreviation:</bold>
MRI, magnetic resonance imaging.</p>
</caption>
<graphic xlink:href="tcrm-13-1449Fig1"></graphic>
</fig>
<fig id="f2-tcrm-13-1449" position="float">
<label>Figure 2</label>
<caption>
<p>Pelvis images of bilateral hips from a 35-year-old female patient who received left artificial hip joint replacement.</p>
<p>
<bold>Note:</bold>
Image shows pelvis X-ray film at 5 years after surgery, and the change of the left hip joint with flattening and sclerosis of the right femoral head.</p>
</caption>
<graphic xlink:href="tcrm-13-1449Fig2"></graphic>
</fig>
<table-wrap id="t1-tcrm-13-1449" position="float">
<label>Table 1</label>
<caption>
<p>VAS and Harris score of 37 post-SARS ONFH patients before and after treatment</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th rowspan="2" valign="top" align="left" colspan="1">Score</th>
<th rowspan="2" valign="top" align="left" colspan="1">Pre-treatment</th>
<th colspan="5" valign="top" align="left" rowspan="1">Post-treatment
<hr></hr>
</th>
</tr>
<tr>
<th valign="top" align="left" rowspan="1" colspan="1">1 year</th>
<th valign="top" align="left" rowspan="1" colspan="1">3 years</th>
<th valign="top" align="left" rowspan="1" colspan="1">6 years</th>
<th valign="top" align="left" rowspan="1" colspan="1">9 years</th>
<th valign="top" align="left" rowspan="1" colspan="1">12 years</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">VAS</td>
<td valign="top" align="left" rowspan="1" colspan="1">6.81±1.70</td>
<td valign="top" align="left" rowspan="1" colspan="1">6.43±1.66</td>
<td valign="top" align="left" rowspan="1" colspan="1">6.35±1.51</td>
<td valign="top" align="left" rowspan="1" colspan="1">6.00±1.68</td>
<td valign="top" align="left" rowspan="1" colspan="1">4.92±1.82</td>
<td valign="top" align="left" rowspan="1" colspan="1">3.97±2.23</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Harris</td>
<td valign="top" align="left" rowspan="1" colspan="1">74.54±9.92</td>
<td valign="top" align="left" rowspan="1" colspan="1">76.49±8.75</td>
<td valign="top" align="left" rowspan="1" colspan="1">77.11±8.33</td>
<td valign="top" align="left" rowspan="1" colspan="1">77.92±8.01</td>
<td valign="top" align="left" rowspan="1" colspan="1">78.78±8.79</td>
<td valign="top" align="left" rowspan="1" colspan="1">80.14±9.47</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn1-tcrm-13-1449">
<p>
<bold>Notes:</bold>
Data were presented as mean ± standard error of means. For VAS score, the post-treatment values at 1, 3, 6, 9 and 12 years were compared with pre-treatment, the
<italic>p</italic>
-values were 0.014, 0.009, 0.002, 0.000 and 0.000, respectively; for Harris score, the post-treatment values at 1, 3, 6, 9 and 12 years were compared with pre-treatment, the
<italic>p</italic>
-values were 0.017, 0.009, 0.007, 0.003 and 0.001, respectively.</p>
</fn>
<fn id="tfn2-tcrm-13-1449">
<p>
<bold>Abbreviations:</bold>
ONFH, osteonecrosis of the femoral head; SARS, severe acute respiratory syndrome; VAS, visual analog scale.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations>
<list>
<country>
<li>République populaire de Chine</li>
</country>
<settlement>
<li>Tianjin</li>
</settlement>
</list>
<tree>
<noCountry>
<name sortKey="Liu, Tiansheng" sort="Liu, Tiansheng" uniqKey="Liu T" first="Tiansheng" last="Liu">Tiansheng Liu</name>
<name sortKey="Ma, Jinchao" sort="Ma, Jinchao" uniqKey="Ma J" first="Jinchao" last="Ma">Jinchao Ma</name>
<name sortKey="Ma, Xinlong" sort="Ma, Xinlong" uniqKey="Ma X" first="Xinlong" last="Ma">Xinlong Ma</name>
<name sortKey="Wang, Hao" sort="Wang, Hao" uniqKey="Wang H" first="Hao" last="Wang">Hao Wang</name>
<name sortKey="Wang, Qi" sort="Wang, Qi" uniqKey="Wang Q" first="Qi" last="Wang">Qi Wang</name>
</noCountry>
<country name="République populaire de Chine">
<noRegion>
<name sortKey="Su, Bin" sort="Su, Bin" uniqKey="Su B" first="Bin" last="Su">Bin Su</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>

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