目的 观察超声引导下经皮穿刺髋关节腔注射富血小板血浆（PRP）联合经皮银质针热松解治疗早期股骨头坏死（ONFH）的疗效及髋关节存活率。 方法 选取符合国际骨循环学会（ARCO）股骨头坏死Ⅱ期患者56例，按照随机数字表法分为两组：PRP注射联合银质针热松解治疗组（R组）和类固醇药物注射联合银质针热松解治疗组（S组）。两组患者均接受3次注射和1次银质针热松解治疗，每次注射间隔4周，记录治疗前及治疗后3 d、1、3、6、12个月时疼痛数字模拟评分（NRS）、Harris髋关节评分、治疗期间非甾体类抗炎药（依托考昔）和曲马多的使用情况；观察形成ARCO股骨头坏死Ⅲ期的发生率及髋关节手术率。 结果 与治疗前比较，两组患者治疗后1、3、6个月的NRS评分及Harris评分均显著下降（P < 0.05）。与S组相比，R组在治疗后3、6、12个月的NRS评分及的Harris评分均明显降低（P < 0.01）。R组在治疗后3、6、12个月日平均使用非甾体类抗炎药（依托考昔）和曲马多剂量显著低于S组（P < 0.01）。R组ARCO股骨头缺血性坏死Ⅲ期的发生率和髋关节手术率亦显著低于S组（P < 0.05）。 结论 超声引导下髋关节腔注射PRP联合银质针治疗股骨头缺血性坏死，可加快缓解髋部疼痛，有效改善髋关节功能，减少镇痛药物的用量，值得临床选用。

Objective To assess the efficacy and the survival rate of the hip joint following the treatment of osteonecrosis of the femoral head （ONFH） with ultrasound?guided percutaneous intra?articular platelet?rich plasma （PRP） injection in combination with percutaneous silver needle thermalolysis. Methods Fifty?six patients diagnosed with ARCO （Association Research Circulation Osseous） stage Ⅱ ONFH were randomly allocated into two groups. The first group， designated as the PRP injection combined with silver needle thermalolysis group （Group R， n = 28）， and the second group， the steroid injection combined with silver needle thermalolysis group （Group S， n = 28）. Both groups underwent three injections （administered at 4?week intervals） and one session of silver needle thermalolysis. Outcome measures， including the Numerical Rating Scale （NRS） for pain assessment， Harris Hip Score （HHS）， daily consumption of non?steroidal anti?inflammatory drugs （etoricoxib） and tramadol， progression to ARCO stage Ⅲ， and the rates of surgical intervention， were recorded at baseline， 3 days， and 1， 3， 6， and 12 months after the treatment. Results When compared to the baseline， both groups manifested significant decreases in NRS scores and enhancements in HHS at all follow?up time points （P < 0.05）. Specifically， Group R demonstrated more favorable outcomes compared to Group S. At 3， 6， and 12 months， Group R had lower NRS scores （P < 0.01） and more notable improvements in HHS （P < 0.01）. Additionally， the daily analgesic consumption （etoricoxib and tramadol） in Group R was significantly lower than that in Group S at 3， 6， and 12 months （P < 0.01）. Moreover， Group R exhibited a significantly lower progression rate to ARCO stage III and a lower hip replacement surgery rate （P < 0.05）. Conclusions Ultrasound?guided intra?articular PRP injection in combination with silver needle thermalolysis expedites pain alleviation， enhances hip function， reduces analgesic dependence， and retards the progression of ONFH. This approach thus represents a clinically viable option for early?stage intervention.