旋转截骨术配合口服补肾活血汤治疗中青年ARCO Ⅲ期股骨头骨坏死的近期疗效
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摘要
目的:观察旋转截骨术结合术后补肾活血汤口服治疗中青年ARCO Ⅲ期股骨头骨坏死的近期疗效。方法:选取2016年1月至2017年4月江苏省中医院收治的中青年ARCO Ⅲ期股骨头骨坏死患者30例(30髋)作为研究对象,按照随机数字表法分为观察组(n=16)和对照组(n=14),观察组采用旋转截骨术结合术后口服补肾活血汤治疗,对照组仅采用旋转截骨术治疗。观察患者治疗前与治疗12个月后的疼痛视觉模拟评分法(VAS)评分、Harris髋关节功能评分、高选择性(旋股内侧动脉)血管造影结果、骨盆正位片结果差异。结果:治疗12个月后,观察组有效13例,无效3例,对照组有效10例,无效4例,观察组总有效率明显高于对照组,差异有统计学意义(P <0. 05); 2组治疗前VAS疼痛评分分别为(4. 23±1. 17)分,(4. 21±1. 14)分,治疗12个月后分别为(2. 31±1. 15)分,(2. 45±1. 04)分,均有明显降低(P <0. 05),且观察组降低优于对照组,差异有统计学意义(P <0. 05); Harris髋关节功能评分治疗前分别为(68. 87±5. 66)分,(68. 06±5. 23)分,治疗12个月后分别为(88. 23±3. 76)分,(84. 15±3. 15)分,均有明显提高(P <0. 05),且观察组提高水平明显优于对照组,差异有统计学意义(P <0. 05); 2组患者术前高选择性(旋股内侧动脉)血管造影结果均显示旋股内侧动脉通畅,术后12个月观察组有13髋(81. 25%)、观察组10髋(71. 43%)旋股内侧动脉显影; 2组治疗后骨盆正位片结果较术前均有明显改善,差异有统计学意义(P <0. 05),且观察组改善程度明显优于对照组,差异有统计学意义(P <0. 05)。结论:运用旋转截骨术结合术后补肾活血汤口服治疗中青年ARCO Ⅲ期股骨头骨坏死,能够减轻患者的疼痛,改善患者的髋关节功能,改善股骨头血运,提高影像学疗效和患者的生命质量。
Objective: To observe the short-term clinical curative effect of rotational osteotomy combined with oral application of Bushen Huoxue Decoction in the treatment of ARCO phase Ⅲ osteonecrosis of femoral head( ONFH) in young and middle-aged patients. Methods: A total of 30 young and middle-aged patients( 30 hips) with ARCO phase Ⅲ ONFH treated in Jiangsu Province Hospital of Chinese Medicine between January 2016 and April 2017 were included in the study and were randomly divided into 2 groups via random number table method,the experiment group of 16 cases( 16 hips) and the control group of 14 cases( 14 hips).Patients of the control group received rotational osteotomy,while patients of the experiment group were orally given Bushen Huoxue Decoction in addition to the same operation as the control group since the third day after the operation. The differences in the results of VAS,Harris Hip Score,high selective( medial femoral circumflex artery) angiography and frontal pelvic radiograph before and after the treatment were compared. Results: Twelve months after the treatment,in the experiment group,the treatment was effective in 13 cases and ineffective in 3 cases; in the control group,it was effective in 10 cases and ineffective in 4 cases. The total effective rate of the experiment group was significantly higher than that of the control group( P < 0. 05). The VAS pain scores of the 2 groups before the treatment were 4. 23 ± 1. 17 and 4. 21 ± 1. 14 respectively. The VAS pain score of the 2 groups at 12 months after the treatment were 2. 31 ± 1. 15 and 2. 45 ± 1. 04 respectively. Both were significantly decreased( P < 0. 05),and the decrease of the experiment group was more significant than that of the control group( P < 0. 05). In terms of the Harris Hip Score,the scorings were 68. 87 ± 5. 66 and 68. 06 ± 5. 23 before the treatment of the experiment group and the control group,and 88. 23 ± 3. 76 and 84. 15 ± 3. 15 in 12 months after the treatment,respectively,which showed significant increase in both groups( P < 0. 05),and that of the experiment group was more significant( P < 0. 05). 12 months after the treatment,13 cases and 10 cases showed good results in angiography of medial femoral circumflex artery in the experiment group and the control group respectively. After the treatment,there was significant improvement in the frontal pelvic radiograph in both group( P < 0. 05),and that of the experiment group was more significant( P < 0. 05). Conclusion: The combined treatment of rotational osteotomy and oral application of Bushen Huoxue Decoction on young and middle-aged patients with ARCO phase Ⅲ osteonecrosis of femoral head can alleviate the pain,improve hip joint function and the blood supply of femoral head,and increase the curative effect of imaging and patient's life quality.
Objective: To observe the short-term clinical curative effect of rotational osteotomy combined with oral application of Bushen Huoxue Decoction in the treatment of ARCO phase Ⅲ osteonecrosis of femoral head( ONFH) in young and middle-aged patients. Methods: A total of 30 young and middle-aged patients( 30 hips) with ARCO phase Ⅲ ONFH treated in Jiangsu Province Hospital of Chinese Medicine between January 2016 and April 2017 were included in the study and were randomly divided into 2 groups via random number table method,the experiment group of 16 cases( 16 hips) and the control group of 14 cases( 14 hips).Patients of the control group received rotational osteotomy,while patients of the experiment group were orally given Bushen Huoxue Decoction in addition to the same operation as the control group since the third day after the operation. The differences in the results of VAS,Harris Hip Score,high selective( medial femoral circumflex artery) angiography and frontal pelvic radiograph before and after the treatment were compared. Results: Twelve months after the treatment,in the experiment group,the treatment was effective in 13 cases and ineffective in 3 cases; in the control group,it was effective in 10 cases and ineffective in 4 cases. The total effective rate of the experiment group was significantly higher than that of the control group( P < 0. 05). The VAS pain scores of the 2 groups before the treatment were 4. 23 ± 1. 17 and 4. 21 ± 1. 14 respectively. The VAS pain score of the 2 groups at 12 months after the treatment were 2. 31 ± 1. 15 and 2. 45 ± 1. 04 respectively. Both were significantly decreased( P < 0. 05),and the decrease of the experiment group was more significant than that of the control group( P < 0. 05). In terms of the Harris Hip Score,the scorings were 68. 87 ± 5. 66 and 68. 06 ± 5. 23 before the treatment of the experiment group and the control group,and 88. 23 ± 3. 76 and 84. 15 ± 3. 15 in 12 months after the treatment,respectively,which showed significant increase in both groups( P < 0. 05),and that of the experiment group was more significant( P < 0. 05). 12 months after the treatment,13 cases and 10 cases showed good results in angiography of medial femoral circumflex artery in the experiment group and the control group respectively. After the treatment,there was significant improvement in the frontal pelvic radiograph in both group( P < 0. 05),and that of the experiment group was more significant( P < 0. 05). Conclusion: The combined treatment of rotational osteotomy and oral application of Bushen Huoxue Decoction on young and middle-aged patients with ARCO phase Ⅲ osteonecrosis of femoral head can alleviate the pain,improve hip joint function and the blood supply of femoral head,and increase the curative effect of imaging and patient's life quality.
引文
[1]赵德伟,胡永成,医学会骨科分会显微修复学组及中国修复重建外科专业委员会骨缺损及骨坏死学组.成人股骨头坏死诊疗标准专家共识(2012年版)[J].中华关节外科杂志(连续型电子期刊),2012,6(3):89-92.
[2]国家中医药管理局.中华人民共和国中医药行业标准---《中医病证诊断疗效标准》[J].中医药管理杂志,1994,1(6):2.
[3]李锐军,蔡荣辉,何智勇.全髋关节置换术后关节功能4种定量指标变化及Harris评分分析[J].中国骨科临床与基础研究杂志,2017,9(2):81-85.
[4]陈卫衡,周宇,何海军,等.健脾活骨方治疗早中期非创伤性股骨头坏死的前瞻性临床研究[J].中华关节外科杂志(连续型电子期刊),2013,7(3):287-293.
[5]Kaushik AP,Das A,Cui Q.Osteonecrosis of the femoral head:An update in year 2012[J].World J Orthop,2012,3(5):49-57.
[6]Malizos KN,Karantanas AH,Varitimidis SE,et al.Osteonecrosis of the femoral head:etiology,imaging and treatment[J].Eur J Radiol,2007,63(1):16-28.
[7]Rackwitz L,Eden L,Reppenhagen S,et al.Stem cell-and growth factor-based regenerative therapies for avascular necrosis of the femoral head[J].Stem Cell Res Ther,2012,3(1):7.
[8]Zhao D,Liu B,Wang B,et al.Autologous bone marrow mesenchymal stem cells associated with tantalum rod implantation and vascularized iliac grafting for the treatment of end-stage osteonecrosis of the femoral head[J].Biomed Res Int,2015,2015:240506.
[9]邓云平.股骨头坏死早期治疗方法研究进展[J].西部医学,2017,29(2):292-296.
[10]Mont MA,Jones LC,Hungerford DS.Nontraumatic osteonecrosis of the femoral head:ten years later[J].J Bone Joint Surg Am,2006,88(5):1117-1132.
[11]Petrigliano FA,Lieberman JR.Osteonecrosis of the hip:novel approaches to evaluation and treatment[J].Clin Orthop Relat Res,2007,465:53-62.
[12]Sugioka Y.Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip:a new osteotomy operation[J].Clin Orthop Relat Res,1978(130):191-201.
[13]Merle D'AubignéR,Postel M,et al.Idiopathic necrosis of the femoral head in adults[J].J Bone Joint Surg Br,1965,47(4):612-633.
[14]PATTERSON RJ,BICKEL WH,DAHLIN DC.IDIOPATHIC AVAS-CULAR NECROSIS OF THE HEAD OF THE FEMUR.A STUDYOF FIFTY-TWOCASES[J].J Bone Joint Surg Am,1964,46:267-82.
[15]Atsumi T,Kajiwara T,Hiranuma Y,et al.Transtrochanteric rotational osteotomy for the treatment of non-traumatic osteonecrosis of the femoral head[J].Clin Calcium,2007,17(6):923-930.
[16]Sugioka Y,Hotokebuchi T,Tsutsui H.Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head.Indications and long-term results[J].Clin Orthop Relat Res,1992(277):111-120.
[17]Ikemura S,Yamamoto T,Nakashima Y,et al.Transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head in patients 20 years or younger[J].J Pediatr Orthop,2009,29(3):219-223.
[18]Sonoda K,Yamamoto T,Motomura G,et al.Outcome of transtrochanteric rotational osteotomy for posttraumatic osteonecrosis of the femoral head with a mean follow-up of 12.3 years[J].Arch Orthop Trauma Surg,2015,135(9):1257-1263.
[2]国家中医药管理局.中华人民共和国中医药行业标准---《中医病证诊断疗效标准》[J].中医药管理杂志,1994,1(6):2.
[3]李锐军,蔡荣辉,何智勇.全髋关节置换术后关节功能4种定量指标变化及Harris评分分析[J].中国骨科临床与基础研究杂志,2017,9(2):81-85.
[4]陈卫衡,周宇,何海军,等.健脾活骨方治疗早中期非创伤性股骨头坏死的前瞻性临床研究[J].中华关节外科杂志(连续型电子期刊),2013,7(3):287-293.
[5]Kaushik AP,Das A,Cui Q.Osteonecrosis of the femoral head:An update in year 2012[J].World J Orthop,2012,3(5):49-57.
[6]Malizos KN,Karantanas AH,Varitimidis SE,et al.Osteonecrosis of the femoral head:etiology,imaging and treatment[J].Eur J Radiol,2007,63(1):16-28.
[7]Rackwitz L,Eden L,Reppenhagen S,et al.Stem cell-and growth factor-based regenerative therapies for avascular necrosis of the femoral head[J].Stem Cell Res Ther,2012,3(1):7.
[8]Zhao D,Liu B,Wang B,et al.Autologous bone marrow mesenchymal stem cells associated with tantalum rod implantation and vascularized iliac grafting for the treatment of end-stage osteonecrosis of the femoral head[J].Biomed Res Int,2015,2015:240506.
[9]邓云平.股骨头坏死早期治疗方法研究进展[J].西部医学,2017,29(2):292-296.
[10]Mont MA,Jones LC,Hungerford DS.Nontraumatic osteonecrosis of the femoral head:ten years later[J].J Bone Joint Surg Am,2006,88(5):1117-1132.
[11]Petrigliano FA,Lieberman JR.Osteonecrosis of the hip:novel approaches to evaluation and treatment[J].Clin Orthop Relat Res,2007,465:53-62.
[12]Sugioka Y.Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip:a new osteotomy operation[J].Clin Orthop Relat Res,1978(130):191-201.
[13]Merle D'AubignéR,Postel M,et al.Idiopathic necrosis of the femoral head in adults[J].J Bone Joint Surg Br,1965,47(4):612-633.
[14]PATTERSON RJ,BICKEL WH,DAHLIN DC.IDIOPATHIC AVAS-CULAR NECROSIS OF THE HEAD OF THE FEMUR.A STUDYOF FIFTY-TWOCASES[J].J Bone Joint Surg Am,1964,46:267-82.
[15]Atsumi T,Kajiwara T,Hiranuma Y,et al.Transtrochanteric rotational osteotomy for the treatment of non-traumatic osteonecrosis of the femoral head[J].Clin Calcium,2007,17(6):923-930.
[16]Sugioka Y,Hotokebuchi T,Tsutsui H.Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head.Indications and long-term results[J].Clin Orthop Relat Res,1992(277):111-120.
[17]Ikemura S,Yamamoto T,Nakashima Y,et al.Transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head in patients 20 years or younger[J].J Pediatr Orthop,2009,29(3):219-223.
[18]Sonoda K,Yamamoto T,Motomura G,et al.Outcome of transtrochanteric rotational osteotomy for posttraumatic osteonecrosis of the femoral head with a mean follow-up of 12.3 years[J].Arch Orthop Trauma Surg,2015,135(9):1257-1263.