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[1]賈宇東,李文龍,王會超,等.舒筋通絡(luò)手法在ARCOⅡ期非創(chuàng)傷性股骨頭壞死打壓植骨帶縫匠肌蒂髂骨瓣移植術(shù)后康復(fù)中的應(yīng)用[J].中醫(yī)正骨,2021,33(03):14-19.
　JIA Yudong,LI Wenlong,WANG Huichao,et al.[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(03):14-19.
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舒筋通絡(luò)手法在ARCOⅡ期非創(chuàng)傷性股骨頭壞死打壓植骨帶縫匠肌蒂髂骨瓣移植術(shù)后康復(fù)中的應(yīng)用()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年03期
頁碼:
14-19
欄目:
臨床研究
出版日期:
2021-03-20

文章信息/Info

作者:
賈宇東; 李文龍; 王會超; 朱英杰; 岳辰; 劉又文
(1.河南省洛陽正骨醫(yī)院/河南省骨科醫(yī)院,河南 洛陽 471002; 2.北京中醫(yī)藥大學(xué),北京 100029)
Author(s):
JIA Yudong; LI Wenlong; WANG Huichao; ZHU Yingjie; YUE Chen; LIU Youwen
1.Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China;2.Beijing University of Chinese Medicine,Beijing 100029,China
關(guān)鍵詞:
股骨頭壞死;  骨移植;  肌肉骨骼手法;  臨床試驗
Keywords:
femur head necrosis;  bone transplantation;  musculoskeletal manipulations;  clinical trial
文獻標(biāo)志碼:
A
摘要:
目的:探討筋骨互用平衡論指導(dǎo)下的舒筋通絡(luò)手法在ARCOⅡ期非創(chuàng)傷性股骨頭壞死(osteonecrosis of the femoral head,ONFH)打壓植骨帶縫匠肌蒂髂骨瓣移植術(shù)后康復(fù)中的應(yīng)用價值。方法:回顧性分析2018年8月至2019年6月收治的66例單側(cè)ARCOⅡ期非創(chuàng)傷性O(shè)NFH患者的病例資料。34例行打壓植骨帶縫匠肌蒂髂骨瓣移植術(shù),術(shù)后應(yīng)用筋骨互用平衡論指導(dǎo)下的舒筋通絡(luò)手法治療(聯(lián)合治療組),32例僅行打壓植骨帶縫匠肌蒂髂骨瓣移植術(shù)治療(保髖手術(shù)組)。比較2組患者的Harris髖關(guān)節(jié)評分、髖部疼痛視覺模擬量表(visual analogue scale,VAS)評分及并發(fā)癥發(fā)生情況。結(jié)果:①Harris髖關(guān)節(jié)評分。時間因素和分組因素存在交互效應(yīng)(F=4.092,P=0.011); 2組患者Harris髖關(guān)節(jié)評分總體比較,差異有統(tǒng)計學(xué)意義,即存在分組效應(yīng)(F=8.363,P=0.009); 治療前后不同時間點之間Harris髖關(guān)節(jié)評分的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=83.056,P=0.000); 2組患者Harris髖關(guān)節(jié)評分隨時間延長均呈逐漸升高趨勢,但2組的升高趨勢不完全一致[(67.20±8.89)分,(78.65±5.96)分,(87.70±6.01)分,(88.15±3.84)分,F=51.843,P=0.000;(69.70±7.20)分,(74.95±2.89)分,(81.75±5.38)分,(83.60±3.46)分,F=29.000,P=0.000]; 治療前2組患者的Harris髖關(guān)節(jié)評分比較,差異無統(tǒng)計學(xué)意義(t=-0.978,P=0.334); 治療開始后3個月、6個月、12個月,聯(lián)合治療組的Harris髖關(guān)節(jié)評分均高于保髖手術(shù)組(t=2.498,P=0.017; t=3.299,P=0.002; t=3.938,P=0.000)。②髖部疼痛VAS評分。時間因素和分組因素存在交互效應(yīng)(F=3.373,P=0.024); 2組患者髖部疼痛VAS評分總體比較,差異有統(tǒng)計學(xué)意義,即存在分組效應(yīng)(F=21.111,P=0.000); 治療前后不同時間點之間髖部疼痛VAS評分的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=187.340,P=0.000); 2組患者髖部疼痛VAS評分隨時間延長均呈逐漸降低趨勢,但2組的降低趨勢不完全一致[(4.55±0.83)分,(1.85±0.67)分,(1.40±0.50)分,(1.05±0.22)分,F=151.242,P=0.000;(4.45±0.51)分,(2.40±0.75)分,(1.80±0.62)分,(1.20±0.41)分,F=103.351,P=0.000]; 治療前及治療開始后12個月,2組患者的髖部疼痛VAS評分比較,組間差異均無統(tǒng)計學(xué)意義(t=0.461,P=0.648; t=-1.435,P=0.162); 治療開始后3個月、6個月,聯(lián)合治療組的髖部疼痛VAS評分均低于保髖手術(shù)組(t=-2.437,P=0.020; t=-2.251,P=0.030)。③并發(fā)癥。治療及隨訪期間,2組患者均未出現(xiàn)明顯并發(fā)癥。結(jié)論:ARCOⅡ期非創(chuàng)傷性O(shè)NFH患者行打壓植骨帶縫匠肌蒂髂骨瓣移植術(shù)后,應(yīng)用筋骨互用平衡論指導(dǎo)下的舒筋通絡(luò)手法治療,可以改善術(shù)后早期髖關(guān)節(jié)功能受限情況、加速疼痛癥狀緩解,且安全性較高。
Abstract:
Objective:To explore the applied values of Shujin Tongluo(舒筋通絡(luò),SJTL)manipulation under the guidance of Pingle Zhenggu(平樂正骨,PLZG)equilibrium theory in postoperative rehabilitation of patients who received impaction bone grafting and sartorial-pedicled iliac bone flap transplantation for treatment of ARCO phaseⅡnon-traumatic osteonecrosis of the femoral head(ONFH).Methods:The medical records of 66 patients with unilateral ARCO phaseⅡnon-traumatic ONFH recruited from August 2018 to June 2019 were analyzed retrospectively.Thirty-four patients were treated with SJTL manipulation under the guidance of PLZG equilibrium theory after the surgery of impaction bone grafting and sartorial-pedicled iliac bone flap transplantation(combination therapy group),while the others were merely treated with impaction bone grafting and sartorial-pedicled iliac bone flap transplantation(hip-preserving surgery group).The Harris hip scores,hip pain visual analogue scale(VAS)scores and complications were compared between the 2 groups.Results:There was interaction between time factor and group factor in Harris hip scores(F=4.092,P=0.011).There was statistical difference in Harris hip scores between the 2 groups in general,in other words,there was group effect(F=8.363,P=0.009).There was statistical difference in Harris hip scores between different timepoints before and after the treatment,in other words,there was time effect(F=83.056,P=0.000).The Harris hip scores presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(67.20±8.89,78.65±5.96,87.70±6.01,88.15±3.84 points,F=51.843,P=0.000; 69.70±7.20,74.95±2.89,81.75±5.38,83.60±3.46 points,F=29.000,P=0.000).There was no statistical difference in Harris hip scores between the 2 groups before the treatment(t=-0.978,P=0.334).The Harris hip scores were higher in combination therapy group compared to hip-preserving surgery group at 3,6 and 12 months after the beginning of the treatment(t=2.498,P=0.017; t=3.299,P=0.002; t=3.938,P=0.000).There was interaction between time factor and group factor in hip pain VAS scores(F=3.373,P=0.024).There was statistical difference in hip pain VAS scores between the 2 groups in general,in other words,there was group effect(F=21.111,P=0.000).There was statistical difference in hip pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=187.340,P=0.000).The hip pain VAS scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(4.55±0.83,1.85±0.67,1.40±0.50,1.05±0.22 points,F=151.242,P=0.000; 4.45±0.51,2.40±0.75,1.80±0.62,1.20±0.41 points,F=103.351,P=0.000).There was no statistical difference in hip pain VAS scores between the 2 groups before the treatment and at 12 months after the beginning of the treatment(t=0.461,P=0.648; t=-1.435,P=0.162).The hip pain VAS scores were lower in combination therapy group compared to hip-preserving surgery group at 3 and 6 months after the beginning of the treatment(t=-2.437,P=0.020; t=-2.251,P=0.030).No obvious complications were found in the 2 groups during the treatment and follow-up period.Conclusion:SJTL manipulation under the guidance of PLZG equilibrium theory can improve postoperative early hip function limitation and accelerate pain relief in patients who received impaction bone grafting and sartorial-pedicled iliac bone flap transplantation for treatment of ARCO phaseⅡnon-traumatic ONFH,and it has high safety.

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備注/Memo

備注/Memo:
基金項目:河南省中醫(yī)藥科學(xué)研究專項課題(20-21ZYZD10)
通訊作者:劉又文 E-mail:[email protected]
更新日期/Last Update: 2021-09-01