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[1]張超,姚晨,沈計(jì)榮.微創(chuàng)髓芯減壓打壓支撐植骨術(shù)結(jié)合補(bǔ)腎活血湯口服治療ARCOⅡ、Ⅲ期股骨頭壞死的近期療效觀察[J].中醫(yī)正骨,2016,28(03):20-23.
　ZHANG Chao,YAO Chen,SHEN Jirong.[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(03):20-23.
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微創(chuàng)髓芯減壓打壓支撐植骨術(shù)結(jié)合補(bǔ)腎活血湯口服治療ARCOⅡ、Ⅲ期股骨頭壞死的近期療效觀察()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期數(shù):
2016年03期
頁(yè)碼:
20-23
欄目:
骨科微創(chuàng)技術(shù)
出版日期:
2016-03-20

文章信息/Info

Title:
作者:
張超; 姚晨; 沈計(jì)榮
江蘇省中醫(yī)院,江蘇 南京 210029
Author(s):
ZHANG Chao; YAO Chen; SHEN Jirong
Jiangshu Hospital of Traditional Chinese Medicine,Jiangshu 210029,Nanjing,China
關(guān)鍵詞:
股骨頭壞死;  補(bǔ)腎活血湯;  減壓術(shù); 外科;  骨移植;  治療; 臨床研究性
Keywords:
femur head necrosis;  Bushen Huoxue Tang;  decompression; surgical bone transplantation;  therapies; investigational
摘要:
目的:觀察微創(chuàng)髓芯減壓打壓支撐植骨術(shù)結(jié)合補(bǔ)腎活血湯口服治療ARCOⅡ、Ⅲ期股骨頭壞死(osteonecrosis of the femoral head,ONFH)的近期療效。方法:將符合要求的61例91髖ARCOⅡ、Ⅲ期ONFH患者隨機(jī)分為2組,聯(lián)合治療組32例47髖、手術(shù)治療組29例44髖。2組均行微創(chuàng)髓芯減壓、死骨清理、打壓植骨、異體腓骨支撐術(shù)。聯(lián)合治療組在術(shù)后第3天開(kāi)始服用補(bǔ)腎活血湯,每天1劑,連續(xù)服用6個(gè)月。采用陳衛(wèi)衡教授制定的影像學(xué)評(píng)價(jià)標(biāo)準(zhǔn),利用X線片評(píng)定患者治療后股骨頭形態(tài)的穩(wěn)定性,同時(shí)采用Harris髖關(guān)節(jié)功能評(píng)分量表評(píng)定髖關(guān)節(jié)功能。結(jié)果:治療后12個(gè)月,按照陳衛(wèi)衡教授制定的影像學(xué)標(biāo)準(zhǔn)評(píng)定,聯(lián)合治療組穩(wěn)定39髖、加重8髖,手術(shù)治療組穩(wěn)定36髖、加重8髖; 2組患者股骨頭形態(tài)穩(wěn)定性比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(Z=-0.145,P=0.885)。治療前2組患者的Harris評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=4.629,P=0.190); 治療后12個(gè)月2組患者的Harris評(píng)分均增加[(69.97±5.77)分,(89.00±2.70)分,t=19.965,P=0.000;(69.09±5.02)分,(85.84±2.93)分,t=18.654,P=0.000],聯(lián)合治療組的評(píng)分高于手術(shù)治療組(t=5.355,P=0.000)。結(jié)論:微創(chuàng)髓芯減壓打壓支撐植骨術(shù)在短期內(nèi)可有效防止ARCOⅡ、Ⅲ期ONFH患者股骨頭塌陷,配合口服補(bǔ)腎活血湯則更有利于患者關(guān)節(jié)功能恢復(fù)。
Abstract:
Objective:To observe the short-term clinical curative effect of minimally invasive core decompression combined with impaction bone grafting and oral application of Bushen Huoxue Tang(補(bǔ)腎活血湯,BSHXT)in the treatment of ARCO phaseⅡandⅢosteonecrosis of the femoral head(ONFH).Methods:Sixty-one patients(91 hips)with ARCO phaseⅡandⅢphase ONFH were enrolled in the study and were randomly divided into 2 groups,32 cases(47 hips)in combination therapy group,29 cases(44 hips)in operation group.The patients in the 2 groups were treated with minimally invasive core decompression,debridement of sequestrum,impaction bone grafting and support with allogeneic fibula.Moreover,the patients in the combination therapy group were treated with oral application of BSHXT since the third day after the operation,one dose a day for 6 consecutive weeks.The morphological stability of the femoral head were evaluated after the treatment according to radiographic evaluation criterion made by professor CHEN Weiheng,meanwhile,hip functions were evaluated by using Harris hip function scale.Results:According to the radiographic evaluation criterion made by professor CHEN Weiheng,39 hips got good stability and 8 hips got poor stability in combination therapy group,while 36 hips got good stability and 8 hips got poor stability in operation group at 12 months after the treatment.There was no statistical difference in the morphological stability of the femoral head between the 2 groups(Z=-0.145,P=0.885).There was no statistical difference in Harris scores between the 2 groups before treatment(t=4.629,P=0.190).Harris scores increased in both of the 2 groups at 12 months after the treatment(69.97+/-5.77 vs 89.00+/-2.70 points,t=19.965,P=0.000; 69.09+/-5.02 vs 85.84+/-2.93 points,t=18.654,P=0.000).Harris scores were higher in combination therapy group compared to operation group(t=5.355,P=0.000).Conclusion:Minimally invasive core decompression combined with impaction bone grafting can effectively prevent the collapse of femoral head of patients with ARCO phaseⅡandⅢONFH,and additional oral application of BSHXT is conducive to hip functional rehabilitation.

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備注/Memo

備注/Memo:
基金項(xiàng)目:江蘇省南京市科技局項(xiàng)目(201303044)
通訊作者:沈計(jì)榮 E-mail:[email protected]
更新日期/Last Update: 2016-03-30