身痛逐瘀汤治疗对股骨头坏死患者血液流变学的影响
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摘要
目的:观察身痛逐瘀汤治疗对股骨头坏死的临床疗效,探讨其对血液流变学的影响。方法:选取2017年1月至2018年1月宝鸡市中心医院收治的股骨头坏死患者60例,按照随机数字表法分为对照组和观察组,每组30例。2组患者均接受股骨头坏死常规治疗,对照组在基础方案上加体外冲击波治疗,观察组在对照组治疗方案基础上应用身痛逐瘀汤治疗,1剂/d。2组均连续治疗8周,比较2组患者治疗前后生命质量评分(SF-36生命质量量表)、髋关节Harris评分、McMillan疼痛评估表、骨密度、骨钙素以及血液流变学的改变。结果:2组治疗后SF-36生命质量量表评分均较治疗前增加,差异有统计学意义(P <0. 05),其中观察组增加优于对照组,差异有统计学意义(P <0. 05); 2组治疗后髋关节Harris评分均较治疗前增加,差异有统计学意义(P <0. 05),其中观察组优于对照组,差异有统计学意义(P <0. 05); 2组治疗后FPSR疼痛评分均较治疗前下降,差异有统计学意义(P <0. 05),其中观察组下降的趋势更明显,差异有统计学意义(P <0. 05); 2组治疗后骨密度、骨钙素均较治疗前升高,差异有统计学意义(P <0. 05),其中观察组增加优于对照组,差异有统计学意义(P <0. 05);治疗后2组患者的全血低切还原黏度(LRV)、全血中切还原黏度(MRV)、全血高切还原黏度(HRV)、血浆黏度(PV)和纤维蛋白原(Fib)均较治疗前下降,其中观察组下降更为明显,差异有统计学意义(P <0. 05)。结论:身痛逐瘀汤对股骨头坏死有理想疗效,其作用机制可能与改善患者血液流变学有关。
Objective: To observe the clinical effects of Shentong Zhuyu Decoction on osteonecrosis of the femoral head,and to explore the effects of hemorheological changes. Methods: A total of 60 patients with osteonecrosis of the femoral head admitted to Baoji Central Hospital were randomly divided into control group and observation group,with 30 cases in each group. The two groups were treated with conventional treatment of osteonecrosis of femoral head. The control group was treated with extracorporeal shock wave therapy in addition to basic plan,on the basis of which the observation group was given Shentong Zhuyu Decoction 1 doses/day,and 200 m L decoction in the morning and evening. The two groups were treated continuously for 8 weeks. The quality of life score (SF-36 quality of life scale),hip joint Harris score,McMillan pain assessment table,bone density,osteocalcin and hemorheological indexes were compared before and after treatment in two groups. Results: The score of SF-36 quality of life in the two groups was increased (P < 0. 05),and the increase of the observation group was better than that of the control group (P < 0. 05);the Harris score of the hip joint was increased after treatment (P < 0. 05),and the observation group was superior to the control group (P < 0. 05); the FPS-R pain scores in the two groups were decreased than that before the treatment (P < 0. 05),and the decrease in the observation group was more obvious (P < 0. 05); the bone mineral density and osteocalcin in the two groups were increased after the treatment (P < 0. 05),and the observation group was better than the control group (P < 0. 05); after treatment,the whole blood low reduction viscosity (LRV),the whole blood middle reduction viscosity (MRV),and the whole blood high reduction viscosity (HRV),plasma viscosity (PV) and fibrinogen (Fib) were decreased than those before treatment,and the decrease in the observation group was more obvious (P < 0. 05). Conclusion: Shentong Zhuyu Decoction has an ideal effect on osteonecrosis of the femoral head,and its mechanism may be related to the improvement of hemorheology.
Objective: To observe the clinical effects of Shentong Zhuyu Decoction on osteonecrosis of the femoral head,and to explore the effects of hemorheological changes. Methods: A total of 60 patients with osteonecrosis of the femoral head admitted to Baoji Central Hospital were randomly divided into control group and observation group,with 30 cases in each group. The two groups were treated with conventional treatment of osteonecrosis of femoral head. The control group was treated with extracorporeal shock wave therapy in addition to basic plan,on the basis of which the observation group was given Shentong Zhuyu Decoction 1 doses/day,and 200 m L decoction in the morning and evening. The two groups were treated continuously for 8 weeks. The quality of life score (SF-36 quality of life scale),hip joint Harris score,McMillan pain assessment table,bone density,osteocalcin and hemorheological indexes were compared before and after treatment in two groups. Results: The score of SF-36 quality of life in the two groups was increased (P < 0. 05),and the increase of the observation group was better than that of the control group (P < 0. 05);the Harris score of the hip joint was increased after treatment (P < 0. 05),and the observation group was superior to the control group (P < 0. 05); the FPS-R pain scores in the two groups were decreased than that before the treatment (P < 0. 05),and the decrease in the observation group was more obvious (P < 0. 05); the bone mineral density and osteocalcin in the two groups were increased after the treatment (P < 0. 05),and the observation group was better than the control group (P < 0. 05); after treatment,the whole blood low reduction viscosity (LRV),the whole blood middle reduction viscosity (MRV),and the whole blood high reduction viscosity (HRV),plasma viscosity (PV) and fibrinogen (Fib) were decreased than those before treatment,and the decrease in the observation group was more obvious (P < 0. 05). Conclusion: Shentong Zhuyu Decoction has an ideal effect on osteonecrosis of the femoral head,and its mechanism may be related to the improvement of hemorheology.
引文
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[5]张延辉,刘琳琳,郝琳娜.身痛逐瘀汤对腰椎间盘突出症患者疼痛程度和生存质量评定的影响[J].中国食物与营养,2014,20(7):84-87.
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[8]陈跃平.酒精对特发性股骨头坏死骨髓成骨微环境作用机制研究[D].广州:南方医科大学,2014.
[9]曾红才.自体骨髓间充质干细胞植入联合髓芯减压植骨支撑术治疗早中期股骨头坏死的临床研究[J].实用中西医结合临床,2018,18(9):44-46.
[10]刘雷,王建伟.股骨头坏死的中医辨证及治疗现状[J].湖北中医药大学学报,2012,14(3):74-76.
[11]黄世金.肾虚血瘀型股骨头坏死临床、病理及影像学相关研究[D].广州:广州中医药大学,2016.
[12]袁普卫,康武林,刘德玉,等.中医对股骨头缺血性坏死病因病机的认识[J].现代中医药,2013,33(6):90-93.
[13]耿嘉玮,朱蜀云,葛永潮,等.芪参活骨方治疗脾肾两虚、瘀血阻络型股骨头坏死60例临床观察[J].中医杂志,2017,58(22):1943-1946.
[14]石雷,柳根哲.身痛逐瘀汤联合磁振热治疗腰椎间盘突出症(血瘀气滞型)的临床观察[J].世界中医药,2016,11(9):1728-1731.
[15]刘学俭,刘立平,吴启梅,等.身痛逐瘀汤治疗腰椎间盘突出症疗效观察[J].湖北中医杂志,2017,39(2):38-39.
[16]刘雷,王建伟.股骨头坏死的中医辨证及治疗现状[J].湖北中医药大学学报,2012,14(3):74-76.
[2]李子荣.股骨头坏死临床诊疗规范(2015年版)[J].中华关节外科杂志(连续型电子期刊),2015,9(1):133-138.
[3]鲁超,马凰富,张兵,等.非创伤性股骨头坏死的中医证候特点研究[J].中华中医药杂志,2014,29(7):2189-2193.
[4]王晓辉,张广敏.中医综合治疗股骨头坏死对照观察[J].实用中医内科杂志,2012,26(11S):49-50.
[5]张延辉,刘琳琳,郝琳娜.身痛逐瘀汤对腰椎间盘突出症患者疼痛程度和生存质量评定的影响[J].中国食物与营养,2014,20(7):84-87.
[6]阮洪生,刘树民.身痛逐瘀汤治疗骨伤科疾病临床研究进展[J].中国实验方剂学杂志,2011,17(9):275-277.
[7]曾荣,张曦.低分子肝素钙联合身痛逐瘀汤预防股骨骨折后深静脉血栓的临床疗效[J].中国临床医生杂志,2015,43(12):69-72.
[8]陈跃平.酒精对特发性股骨头坏死骨髓成骨微环境作用机制研究[D].广州:南方医科大学,2014.
[9]曾红才.自体骨髓间充质干细胞植入联合髓芯减压植骨支撑术治疗早中期股骨头坏死的临床研究[J].实用中西医结合临床,2018,18(9):44-46.
[10]刘雷,王建伟.股骨头坏死的中医辨证及治疗现状[J].湖北中医药大学学报,2012,14(3):74-76.
[11]黄世金.肾虚血瘀型股骨头坏死临床、病理及影像学相关研究[D].广州:广州中医药大学,2016.
[12]袁普卫,康武林,刘德玉,等.中医对股骨头缺血性坏死病因病机的认识[J].现代中医药,2013,33(6):90-93.
[13]耿嘉玮,朱蜀云,葛永潮,等.芪参活骨方治疗脾肾两虚、瘀血阻络型股骨头坏死60例临床观察[J].中医杂志,2017,58(22):1943-1946.
[14]石雷,柳根哲.身痛逐瘀汤联合磁振热治疗腰椎间盘突出症(血瘀气滞型)的临床观察[J].世界中医药,2016,11(9):1728-1731.
[15]刘学俭,刘立平,吴启梅,等.身痛逐瘀汤治疗腰椎间盘突出症疗效观察[J].湖北中医杂志,2017,39(2):38-39.
[16]刘雷,王建伟.股骨头坏死的中医辨证及治疗现状[J].湖北中医药大学学报,2012,14(3):74-76.