介入联合中药保髋治疗非创伤性股骨头坏死的研究  

Research of intervention combined Chinese medicine hip-preserving treatment for non-traumatic femoral head necrosis

作　　者：周勇[1] 丰凡翔 斯光宴[1] 徐燕能 徐祖健[1] 

机构地区：[1]泸州医学院附属中医医院,四川泸州646000

出　　处：《泸州医学院学报》2014年第4期407-410,共4页Journal of Luzhou Medical College

基　　金：四川省泸州市科技局课题(2010-S-15(7/8))

摘　　要：目的:观察介入联合中药保髋治疗非创伤性股骨头坏死的近期临床疗效及治疗前后不同时间节点的Harris评分改变。方法:对我院收治的39例(70髋)非创伤性股骨头坏死患者,采用微创介入于患髋血管内注入骨肽、血栓通、丹参、尿激酶,术后予以骨肽、葛根素静脉输入1周后出院,门诊继续服中药汤剂治疗2个疗程并随访半年以上。以Harris髋关节评分表和影像学检查作为疗效评价指标。结果:2例双侧股骨头坏死因一侧治疗1个疗程无效而行单侧关节置换,37例(68髋)获得完整治疗和随访,临床痊愈34髋,有效21髋,无效15髋,总有效率78.57%。治疗前总体Harris评分为72.82±14.59分,治疗后为91.30±8.99分,治疗后Harris评分显著高于治疗前,差异有统计学意义(P<0.05);不同时间节点Harris评分比较:术后1周、3月、6月的Harris评分均显著高于术前,差异有统计学意义(P<0.05),术后3月的Harris评分较术后1周的评分降低,差异有统计学意义(P<0.05),术后6月的Harris评分高于术后1周和术后3月,差异有统计学意义(P<0.05)。末次随访影像学表现:稳定48髋,稳定率为76.19%;ARCO分期,Ⅱ期稳定率85.71%,Ⅲ期稳定率64.29%,Ⅱ期稳定率显著高于Ⅲ期,差异具有统计学意义(P<0.05)。结论:采用介入联合中药治疗非创伤性股骨头坏死近期临床疗效显著,对ARCOⅡ期患者在保持股骨头稳定,防止塌陷方面效果较好,能改善ARCOⅢ期患者临床症状和关节活动功能,在治疗过程中病情虽有反弹,但坚持用药,疾病可获得进一步好转,为骨头坏死的保髋治疗方法之一。Objective： To observe the clinical effect of intervention combined Chinese medicine hip-preserving treatment on non-traumatic osteonecrosis of femoral head. Methods： 39 cases（70 hips） of non-traumatic femoral head necrosis were injected with Ossotide, Xue shuantong, Dan shen and urokinase into the vessels of suffered hip through minimally invasive intervention, After operation, patients received intravenous infusion of Osseotide and Gegensu for a week and discharged. Then patients took two courses of Chinese medicine treatment at outpatient department and followed-up for more than six months.Harris hip scale and imaging examination were used for effectiveness evaluation. Results： Two cases were converted to joint replacement, 37cases（68 hips） obtained complete treatment and followed-up. 34 hips were Clinically cured,21 hips were effective,15 hips were invalid.The total effective rate was 78.57%.The overall harris score from 2.82 ± 14.59 before treatment increased to 91.30 ± 8.99 and after treatment（P 〈0.05）.The harris scores postoperation were significantly higher than preoperation（P 〈0.05）. 3 months postoperation was lower than one week postoperation（P 〈0.05） and 6 months postoperation was higher than one week and 3 months postoperation（P 〈0.05）.The last followed-up imagings showed that 48 hips were stable.The stability factor was 76.19%. The stability factor in ARCO stageⅡ（85.71%） was higher than that in stageⅢ（64.29%）（P 〈0.05）. Conclusions： The clinical effect of intervention combined Chinese medicine treatment on non-traumatic necrosis of femoral head is significant.It is beneficial to ARCO stage Ⅱ patients in keeping femoral head stable and preventing its collapse.It can improve ARCO stage Ⅲ Patient＇s clinical symptoms and function of hip joints.Although it might rebound in some patients,but improvement will be achieved if they adhere to the treatment plan.

关 键 词：非创伤性股骨头坏死 介入 中药 保髋治疗 

分 类 号：R274[医药卫生—中医骨伤科学]