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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第23卷

期數:

2011年02期

頁碼:

7-10

欄目:

臨床研究

出版日期:

2011-02-25

文章信息/Info

Title:

Steroid-induced avascular necrosis of the femoral head in the early dialectical therapy and Clinical Evaluation

作者:

王梅; 張妙林

杭州師范學院醫(yī)學院附屬余杭醫(yī)院,浙江 杭州 311100

Author(s):

WANG Mei^*; ZHANG Miao-lin.^*

Yuhang Hospital,The Clinical Medical School of Hangzhou Teachers college,Hangzhou 311100,Zhejiang,China

關鍵詞:

股骨頭壞死 療效評價 活骨湯 髓芯減壓術 植骨術

Keywords:

Femur Head Necrosis;  Clinical Evaluation;  Huogutang;  myeloid core decompression;  bone graft

摘要:

目的:應用中藥結合髓芯減壓植骨術來提高早期激素性股骨頭壞死的療效,并對其結果進行臨床療效和MRI評價。方法:選擇自2004年8月至2009年8月間我院收治的已明確病因的早期激素性股骨頭缺血性壞死(SANFH)病人60例,按ARCO 分期將Ⅰ、Ⅱ期定為早期,隨機分為對照組和治療組各30 例。對照組30 例單純采用活骨湯加減,每天1劑,分2次服用,連服6 個月,其后中藥制成丸劑口服6 個月,連續(xù)共計12 個月; 治療組30 例,先采用股骨頭髓芯減壓術,再依據辯證分型中藥湯劑內服,以活骨湯為基礎方,同上加減補益肝腎之品,服用方法亦同上。所有患者每3個月復查X 線片,分別于治療后半年、1 年、1.5 年、2 年隨診復查進行臨床療效評價,每年行MR 檢查1 次。本次臨床試驗末次隨訪結果均采用治療后1 年的隨訪結果。結果:在臨床癥狀體征、X線表現的改善方面,治療組明顯優(yōu)于對照組,有極顯著差異(P<0.01)。對兩組治療前、末次隨訪評分分別進行比較,末次隨訪的兩組較治療前均有極顯著性差異(P<0.01)。在減輕骨內壓、改善骨內循環(huán)、促進股骨頭修復方面(“線樣征”、骨髓水腫 ),治療組明顯優(yōu)于對照組,有統計學意義(P<0.05)。結論:①早期(Ⅰ、Ⅱ期)SANFH 采用活骨湯加減治療對改善臨床癥狀及X線表現有一定療效。②中藥(活骨湯加減)結合髓芯減壓的治療方法,能同時改善股骨頭內血液循環(huán),減輕骨內壓,并通過植骨提供必要的支撐,防止軟骨塌陷,無論從臨床療效及X線療效評分進行比較,還是從MRI骨髓水腫、線樣征兩方面進行評估,較之單用中藥治療的方法療效更可靠。

Abstract:

Objective:Using Chinese medicine dialectical to improve the treatment of early necrosis of the femoral head,at the same time we hope to perfect the system of the efficacy of Evaluation. So the system will be more comprehensive.Methods:We chose 60 cases of Steroid-induced avascular necrosis of the femoral head(SANFH)patients Since August 2004 to August 2009, according to ARCO,ⅠandⅡtype was early necrosis of the femoral head,all patients were randomly divided into control group of 30 patients and the treatment group of 30 patients. The control group of 30 patients were used in the treatment of Huogutang,two times per day,continued for six months,at last six months used Chinese medicine pill. the treatment group have adopted myeloid core decompression of the femoral head,and then under the Chinese dialectical type,use huogutang and buyiganshen,the dosed medicine as the same. the treatment group have adopted myeloid core decompression of the femoral head,and then under the Chinese dialectical type,use huogutang and buyiganshen,the dosed medicine as the same. All patients would be chected X-ray every three months, six months after treatment,1,1.5,2-year follow-up would be reviewed of the clinical evaluation, and the annual inspection of MR. We chose the one-year follow-up results to be this clinical trial results.Results:In clinical symptoms, signs and X-ray performance improvements, the treatment group was significantly better than the control group(P<0.01). treatment compared with the controlled type and treatment type was a very significant differences(P<0.01). In the bone to reduce pressure and improvecirculation within the bone, and promote restoration of the femoral head(“Line-sign”,bone marrow edema), the treatment group was better than the control group(P<0.05).Conclusion:Early(Ⅰ,Ⅱ)SANFH using Huogutangjiajian dialectical therapy have improved the clinical symptoms and X-ray changes of significant. Huogutang combined with myeloid core decompression of the femoral head can improve the blood supply of femoral head,compressed the pressure of bone.and then use bone graft supply sustentation of bone,prevent cartilage sink. compared with clinical effect、x ray effect、bone marrow edema and Line-sign of MRI effect,the clinical effect is significant than single use Chinese medicine.

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更新日期/Last Update: 2011-02-25