[1]姚晨,沈计荣,杜斌,等.口服补肾活血汤联合微创保髋术治疗股骨头坏死肾虚血瘀证的临床研究[J].中医正骨,2016,28(11):7-12.
 YAO Chen,SHEN Jirong,DU Bin,et al.Clinical study on oral application of Bushen Huoxue Tang(补肾活血汤)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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口服补肾活血汤联合微创保髋术治疗股骨头坏死肾虚血瘀证的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年11期
页码:
7-12
栏目:
临床研究
出版日期:
2016-11-20

文章信息/Info

Title:
Clinical study on oral application of Bushen Huoxue Tang(补肾活血汤)combined with minimally invasive hip-preserving surgery for treatment of kidney-deficiency-blood-stasis-type osteonecrosis of femoral head
作者:
姚晨沈计荣杜斌孙光权张超
江苏省中医院,江苏 南京 210019
Author(s):
YAO ChenSHEN JirongDU BinSUN GuangquanZHANG Chao
Jiangsu Provincial Hospital of Traditional Chinese Medicine,Nanjing 210019,Jiangsu,China
关键词:
股骨头坏死 肾虚 血瘀 中药疗法 补肾活血汤 外科手术微创性 临床试验
Keywords:
femur head necrosis kidney deficiency blood stasis drug therapy(TCD) Bushen Huoxue Tang surgical proceduresminimally invasive clinical trial
摘要:
目的:探讨口服补肾活血汤联合微创保髋术治疗股骨头坏死肾虚血瘀证的临床疗效和安全性。方法:回顾性分析52例60髋股骨头坏死肾虚血瘀证患者的病例资料,其中采用单纯微创保髋术28例,采用口服补肾活血汤联合微创保髋术24例。男30例37髋,女22例23髋。年龄26~48岁,中位数34岁。激素性股骨头坏死30例31髋,酒精性股骨头坏死20例27髋,外伤性股骨头坏死2例2髋。按照国际骨循环研究会(the association research circulation osseous,ARCO)分期标准,ⅡA3例3髋、ⅡB35例43髋、ⅡC14例14髋。比较2组患者治疗前和治疗后12个月的Harris髋关节功能评分、治疗后并发症发生情况及治疗后12个月根据Harris总评分评价的临床综合疗效。结果:治疗前2组患者的Harris髋关节功能评分比较,差异无统计学意义[(17.1±4.8)分,(16.8±4.7)分,t=-0.532,P=0.684]; 治疗后12个月,口服补肾活血汤联合微创保髋术组的Harris髋关节功能评分高于微创保髋术组[(41.2±2.9)分,(39.8±3.6)分,t=-3.175,P=0.012],2组患者的Harris髋关节功能评分均增加(t=-13.520,P=0.001; t=-12.790,P=0.001)。治疗后12个月,微创保髋手术组Harris总评分(89.5±4.7)分,口服补肾活血汤联合微创保髋术组Harris总评分(90.3±3.8)分; 微创保髋术组优16例、良10例、差2例,口服补肾活血汤联合微创保髋术组优16例、良7例、差1例; 2组患者的临床综合疗效比较,差异无统计学意义(Z=0.729,P=0.466)。单纯微创保髋术组出现不明原因发热及手术切口周围肿痛1例、股骨头塌陷2例,口服补肾活血汤联合微创保髋术组出现不明原因的疼痛加重1例; 2组并发症发生率比较,差异无统计学意义(χ2=0.131,P=0.718)。结论:对于股骨头坏死肾虚血瘀证患者而言,口服补肾活血汤联合微创保髋术与单纯微创保髋术在临床综合疗效、安全性方面比较无明显差异,但是其在改善髋关节功能方面优于单纯微创保髋术,值得临床推广应用。
Abstract:
Objective:To observe the clinical curative effects and safety of oral application of Bushen Huoxue Tang(补肾活血汤,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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备注/Memo

备注/Memo:
基金项目:南京市科技发展计划项目(201303044)
通讯作者:沈计荣 E-mail:joint66118@sina.com
更新日期/Last Update: 2016-11-30