益肾活血方治疗早中期非创性股骨头坏死的临床观察  

Clinical observation of Yishen Huoxue decoction(益肾活血方,YSHXD) for the treatment of non-traumatic osteonecrosis of femoral head at early and middle stage

作　　者：刘冠虹[1] 吉万波[1] 刘锦涛[1] 姜宏[1] LIU Guan-hong;JI Wan-bo;LIU Jin-tao;JIANG Hong(Department of Orthopaedics,Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine,Suzhou 215000,Jiangsu,China)

机构地区：[1]南京中医药大学附属苏州市中医医院骨科

出　　处：《中国骨伤》2019年第11期1003-1007,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:观察益肾活血方治疗早中期非创伤性股骨头坏死的临床疗效.方法:自2010年1月至2016年6月,将69例(72髋)早中期非创伤性股骨头坏死患者按照治疗方法不同分为治疗组和对照组.治疗组35例43髋,其中男15例,女20例;年龄28~62 (41.80±11.03)岁;ARCO分期Ⅰ期6髋,Ⅱ期27髋,Ⅲa期10髋;口服益肾活血方,每日1剂,早晚分服,服用12个月.对照组34例39髋,其中男16例,女18例;年龄31~61 (43.35±13.52)岁;ARCO分期Ⅰ期5髋,Ⅱ期26髋,Ⅲa期8髋,口服阿仑膦酸钠片70 mg,每周1次,服用12个月.记录治疗前和治疗后2年随访时Harris评分,采用EQ-5D指数进行疗效比较.以ARCO分期作为影像学评价,随访期间出现ARCO分期>Ⅲa期为观察终点,记录末次随访时间及ARCO分期,进行Kaplan-Meier生存分析.结果:所有患者获得随访,时间26~76(43.50±13.26)个月.随访2年后治疗组Harris评分(84.92±7.56)分高于治疗前(73.58±10.02)分(P<0.05),并且高于对照组(79.61±10.92)分(P<0.05),其中关节功能、活动度分值高于对照组(P<0.05).治疗组EQ-5D指数0.66±0.12,高于对照组0.59±0.12(P<0.05).末次随访时治疗组塌陷9髋(9/43),对照组塌陷10髋(10/39),两组比较差异无统计学意义(P>0.05).两组Kaplan-Meier生存分析曲线比较差异无统计学意义(P>0.05);ARCO早期与中期、不同Harris评价间生存率比较差异有统计学意义.结论:益肾活血方治疗早中期非创伤性股骨头坏死疗效显著,可改善髋关节功能,提高患者生存质量,延缓股骨头坏死塌陷进程.Objective:To observe clinical efficacy of Yishen Huoxue decoction(益肾活血方,YSHXD)for the treatment of non-traumatic osteonecrosis of femoral head at early and middle stage.Methods:From January to June 2016,69 patients(72 hips)with non-traumatic osteonecrosis of femoral head at early and middle stage were divided into treatment group and control group according to therapeutic methods.In treatment group,there were 35 patients 43 hips,including 15 males and 20 females,aged from 28 to 62 years old with an average of(41.80±11.03)years old,6 hips were at the stageⅠ,27 hips were at the stageⅡ,10 hips were at the stageⅢa according to ARCO classification;and treated by using YSHXD,one dose a day for 12 months.In control group,there were 34 patients 39 hips,including 16 males and 18 females,aged from 31 to 61 years old with an average of(43.35±13.52)years old,5 hips were at the stageⅠ,26 hips were at the stageⅡ,8 hips were at the stageⅢa according to ARCO classification;and treated by using alendronate sodium tablets 70 mg every week for 12 months.Preoperative and postoperative HSS score at 2 weeks were observed and compared,EQ-5D index was used to compare clinical effects.ARCO classification was applied to imaging evaluation,the stage of ARCO overⅢa was considered as end point of observation.The final following-up time and ARCO classification were recorded and performed Kaplan-Meier survival analysis.Results:All patients were followed-up from 26 to 76 months with an average of(43.50±13.26)months.Postoperative Harris score at 2 years in treatment group(84.92±7.56)was higher than that of before treatment(73.58±10.02)(P<0.05),and higher than that of control group(79.61±10.92)(P<0.05),especially the scores of joint function and activity were higher than those of control group(P<0.05).EQ-5D index in treatment group 0.66±0.12 was higher than that of control group 0.59±0.12(P<0.05).Nine hips were collapsed in treatment group at final follow-up,and 10 hips were collapsed in control group,and had nosta

关 键 词：股骨头坏死 补肾 活血 汤剂 

分 类 号：R684[医药卫生—骨科学]