[1]贾宇东,李文龙,王会超,等.舒筋通络手法在ARCOⅡ期非创伤性股骨头坏死打压植骨带缝匠肌蒂髂骨瓣移植术后康复中的应用[J].中医正骨,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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舒筋通络手法在ARCOⅡ期非创伤性股骨头坏死打压植骨带缝匠肌蒂髂骨瓣移植术后康复中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年03期
页码:
14-19
栏目:
临床研究
出版日期:
2021-03-20

文章信息/Info

作者:
贾宇东; 李文龙; 王会超; 朱英杰; 岳辰; 刘又文
(1.河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002; 2.北京中医药大学,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
关键词:
股骨头坏死;  骨移植;  肌肉骨骼手法;  临床试验
Keywords:
femur head necrosis;  bone transplantation;  musculoskeletal manipulations;  clinical trial
文献标志码:
A
摘要:
目的:探讨筋骨互用平衡论指导下的舒筋通络手法在ARCOⅡ期非创伤性股骨头坏死(osteonecrosis of the femoral head,ONFH)打压植骨带缝匠肌蒂髂骨瓣移植术后康复中的应用价值。方法:回顾性分析2018年8月至2019年6月收治的66例单侧ARCOⅡ期非创伤性ONFH患者的病例资料。34例行打压植骨带缝匠肌蒂髂骨瓣移植术,术后应用筋骨互用平衡论指导下的舒筋通络手法治疗(联合治疗组),32例仅行打压植骨带缝匠肌蒂髂骨瓣移植术治疗(保髋手术组)。比较2组患者的Harris髋关节评分、髋部疼痛视觉模拟量表(visual analogue scale,VAS)评分及并发症发生情况。结果:①Harris髋关节评分。时间因素和分组因素存在交互效应(F=4.092,P=0.011); 2组患者Harris髋关节评分总体比较,差异有统计学意义,即存在分组效应(F=8.363,P=0.009); 治疗前后不同时间点之间Harris髋关节评分的差异有统计学意义,即存在时间效应(F=83.056,P=0.000); 2组患者Harris髋关节评分随时间延长均呈逐渐升高趋势,但2组的升高趋势不完全一致[(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]; 治疗前2组患者的Harris髋关节评分比较,差异无统计学意义(t=-0.978,P=0.334); 治疗开始后3个月、6个月、12个月,联合治疗组的Harris髋关节评分均高于保髋手术组(t=2.498,P=0.017; t=3.299,P=0.002; t=3.938,P=0.000)。②髋部疼痛VAS评分。时间因素和分组因素存在交互效应(F=3.373,P=0.024); 2组患者髋部疼痛VAS评分总体比较,差异有统计学意义,即存在分组效应(F=21.111,P=0.000); 治疗前后不同时间点之间髋部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=187.340,P=0.000); 2组患者髋部疼痛VAS评分随时间延长均呈逐渐降低趋势,但2组的降低趋势不完全一致[(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]; 治疗前及治疗开始后12个月,2组患者的髋部疼痛VAS评分比较,组间差异均无统计学意义(t=0.461,P=0.648; t=-1.435,P=0.162); 治疗开始后3个月、6个月,联合治疗组的髋部疼痛VAS评分均低于保髋手术组(t=-2.437,P=0.020; t=-2.251,P=0.030)。③并发症。治疗及随访期间,2组患者均未出现明显并发症。结论:ARCOⅡ期非创伤性ONFH患者行打压植骨带缝匠肌蒂髂骨瓣移植术后,应用筋骨互用平衡论指导下的舒筋通络手法治疗,可以改善术后早期髋关节功能受限情况、加速疼痛症状缓解,且安全性较高。
Abstract:
Objective:To explore the applied values of Shujin Tongluo(舒筋通络,SJTL)manipulation under the guidance of Pingle Zhenggu(平乐正骨,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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备注/Memo

备注/Memo:
基金项目:河南省中医药科学研究专项课题(20-21ZYZD10)
通讯作者:刘又文 E-mail:liuyouwen543@sina.com
更新日期/Last Update: 2021-09-01