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[1]姚晨,沈計(jì)榮,杜斌,等.口服補(bǔ)腎活血湯聯(lián)合微創(chuàng)保髖術(shù)治療股骨頭壞死腎虛血瘀證的臨床研究[J].中醫(yī)正骨,2016,28(11):7-12.
　YAO Chen,SHEN Jirong,DU Bin,et al.Clinical study on oral application of Bushen Huoxue Tang(補(bǔ)腎活血湯)combined with minimally invasive hip-preserving surgery for treatment of kidney-deficiency-blood-stasis-type osteonecrosis of femoral head[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(11):7-12.
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口服補(bǔ)腎活血湯聯(lián)合微創(chuàng)保髖術(shù)治療股骨頭壞死腎虛血瘀證的臨床研究()
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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11期
頁碼:
7-12
欄目:
臨床研究
出版日期:
2016-11-20

文章信息/Info

Title:
Clinical study on oral application of Bushen Huoxue Tang(補(bǔ)腎活血湯)combined with minimally invasive hip-preserving surgery for treatment of kidney-deficiency-blood-stasis-type osteonecrosis of femoral head
作者:
姚晨; 沈計(jì)榮; 杜斌; 孫光權(quán); 張超
江蘇省中醫(yī)院,江蘇 南京 210019
Author(s):
YAO Chen; SHEN Jirong; DU Bin; SUN Guangquan; ZHANG Chao
Jiangsu Provincial Hospital of Traditional Chinese Medicine,Nanjing 210019,Jiangsu,China
關(guān)鍵詞:
股骨頭壞死;  腎虛;  血瘀;  中藥療法;  補(bǔ)腎活血湯;  外科手術(shù); 微創(chuàng)性;  臨床試驗(yàn)
Keywords:
femur head necrosis;  kidney deficiency;  blood stasis;  drug therapy(TCD);  Bushen Huoxue Tang;  surgical procedures; minimally invasive;  clinical trial
摘要:
目的:探討口服補(bǔ)腎活血湯聯(lián)合微創(chuàng)保髖術(shù)治療股骨頭壞死腎虛血瘀證的臨床療效和安全性。方法:回顧性分析52例60髖股骨頭壞死腎虛血瘀證患者的病例資料,其中采用單純微創(chuàng)保髖術(shù)28例,采用口服補(bǔ)腎活血湯聯(lián)合微創(chuàng)保髖術(shù)24例。男30例37髖,女22例23髖。年齡26～48歲,中位數(shù)34歲。激素性股骨頭壞死30例31髖,酒精性股骨頭壞死20例27髖,外傷性股骨頭壞死2例2髖。按照國際骨循環(huán)研究會(huì)(the association research circulation osseous,ARCO)分期標(biāo)準(zhǔn),ⅡA3例3髖、ⅡB35例43髖、ⅡC14例14髖。比較2組患者治療前和治療后12個(gè)月的Harris髖關(guān)節(jié)功能評(píng)分、治療后并發(fā)癥發(fā)生情況及治療后12個(gè)月根據(jù)Harris總評(píng)分評(píng)價(jià)的臨床綜合療效。結(jié)果:治療前2組患者的Harris髖關(guān)節(jié)功能評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義[(17.1±4.8)分,(16.8±4.7)分,t=-0.532,P=0.684]; 治療后12個(gè)月,口服補(bǔ)腎活血湯聯(lián)合微創(chuàng)保髖術(shù)組的Harris髖關(guān)節(jié)功能評(píng)分高于微創(chuàng)保髖術(shù)組[(41.2±2.9)分,(39.8±3.6)分,t=-3.175,P=0.012],2組患者的Harris髖關(guān)節(jié)功能評(píng)分均增加(t=-13.520,P=0.001; t=-12.790,P=0.001)。治療后12個(gè)月,微創(chuàng)保髖手術(shù)組Harris總評(píng)分(89.5±4.7)分,口服補(bǔ)腎活血湯聯(lián)合微創(chuàng)保髖術(shù)組Harris總評(píng)分(90.3±3.8)分; 微創(chuàng)保髖術(shù)組優(yōu)16例、良10例、差2例,口服補(bǔ)腎活血湯聯(lián)合微創(chuàng)保髖術(shù)組優(yōu)16例、良7例、差1例; 2組患者的臨床綜合療效比較,差異無統(tǒng)計(jì)學(xué)意義(Z=0.729,P=0.466)。單純微創(chuàng)保髖術(shù)組出現(xiàn)不明原因發(fā)熱及手術(shù)切口周圍腫痛1例、股骨頭塌陷2例,口服補(bǔ)腎活血湯聯(lián)合微創(chuàng)保髖術(shù)組出現(xiàn)不明原因的疼痛加重1例; 2組并發(fā)癥發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(χ2=0.131,P=0.718)。結(jié)論:對(duì)于股骨頭壞死腎虛血瘀證患者而言,口服補(bǔ)腎活血湯聯(lián)合微創(chuàng)保髖術(shù)與單純微創(chuàng)保髖術(shù)在臨床綜合療效、安全性方面比較無明顯差異,但是其在改善髖關(guān)節(jié)功能方面優(yōu)于單純微創(chuàng)保髖術(shù),值得臨床推廣應(yīng)用。
Abstract:
Objective:To observe the clinical curative effects and safety of oral application of Bushen Huoxue Tang(補(bǔ)腎活血湯,BSHXT)combined with minimally invasive hip-preserving surgery for the treatment of kidney-deficiency-blood-stasis-type osteonecrosis of femoral head(ONFH).Methods:The medical records of 52 patients with kidney-deficiency-blood-stasis-type ONFH were analyzed retrospectively.Twenty-eight patients were treated with monotherapy of minimally invasive hip-preserving surgery(group A),while the others were treated with oral application of BSHXT combined with minimally invasive hip-preserving surgery(group B).The patients consisted of 30 males(37 hips)and 22 females(23 hips),and ranged in age from 26 to 48 years(Median=34 yrs).The ONFH belonged to steroid-induced ONFH(31 hips in 30 patients),alcohol-induced ONFH(27 hips in 20 patients)and traumatic ONFH(2 hips in 2 patients).According to the staging standard issued by the association research circulation osseous(ARCO),the ONFH belonged to ARCO phaseⅡA(3 hips in 3 patients),ⅡB(43 hips in 35 patients)and ⅡC(14 hips in 14 patients).Harris hip function scores measured before treatment and at 12 months after treatment,posttreatment complications and clinical comprehensive curative effects that evaluated according to Harris total scores at 12 months after treatment were compared between the 2 groups.Results:There was no statistical difference in the Harris hip function scores between the 2 groups before treatment(17.1+/-4.8 vs 16.8+/-4.7 points,t=-0.532,P=0.684).The Harris hip function scores were higher in group B compared to group A at 12 months after treatment(41.2+/-2.9 vs 39.8+/-3.6 points,t=-3.175,P=0.012).The Harris hip function scores increased in both of the 2 groups(t=-13.520,P=0.001; t=-12.790,P=0.001).The Harris total scores was 89.5+/-4.7 points in group A and 90.3+/-3.8 points in group B at 12 months after treatment.Sixteen patients obtained an excellent result,10 good and 2 poor in group A; while 16 patients obtained an excellent result,7 good and 1 poor in group B.There was no statistical difference in the total clinical curative effects between the 2 groups(Z=0.729,P=0.466).The fever of unknown origin and swelling and pain around the incision(1)and femoral head collapse(2)were found in group A,while aggravated pain of unknown origin(1)was found in group B.There was no statistical difference in the complication rate between the 2 groups(χ2=0.131,P=0.718).Conclusion:There are no significant difference in total clinical curative effects and safety between combination of oral application of BSHXT with minimally invasive hip-preserving surgery and monotherapy of minimally invasive hip-preserving surgery for treatment of kidney-deficiency-blood-stasis-type ONFH,however,the former surpasses the latter in improving hip function,so it is worthy of popularizing in clinic.

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備注/Memo

備注/Memo:
基金項(xiàng)目:南京市科技發(fā)展計(jì)劃項(xiàng)目(201303044)
通訊作者:沈計(jì)榮 E-mail:[email protected]
更新日期/Last Update: 2016-11-30