非创伤性股骨头坏死患者的中医证候及疼痛特点  

Characteristics of traditional Chinese medicine syndromes and pain in patients with non-traumatic necrosis of the femoral head

作　　者：何晓铭 魏秋实[2] 何伟[2] 张庆文[2] 曾平[3] 庄至坤 张颖[5] 杨帆 沈莹姗 HE Xiao-ming;WEI Qiu-shi;HE Wei;ZHANG Qing-wen;ZENG Ping;ZHUANG Zhi-kun;ZHANG Ying;YANG Fan;SHEN Ying-shan(First Clinical Medical College,Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Hip Preserving Ward,No.3 Orthopaedic Region,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;The First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530000,China;Quanzhou Bone-setting Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Quanzhou 362000,China;Luoyang Orthopedic-Traumatological Hospital of Henan Province,Luoyang 471000,China)

机构地区：[1]广州中医药大学第一临床医学院,广州510405 [2]广州中医药大学第一附属医院三骨科保髋区,广州510405 [3]广西中医药大学第一附属医院,南宁530000 [4]福建中医药大学附属泉州市正骨医院,泉州362000 [5]河南省洛阳正骨医院,洛阳471000

出　　处：《中华中医药杂志》2020年第7期3656-3659,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金面上项目(No.81473697,No.81573996,No.81873327);广东省科技厅-广东省中医药科学院联合科研专项项目(No.2016A020226028);广东省自然科学基金项目(No.2017A030313698);广东省中医药强省建设专项中医优势病种(股骨头坏死)突破项目(No.粤中医函[2015]19号);广东省名中医(何伟)传承工作室建设项目(No.粤中医办函[2017]17号)。

摘　　要：目的:研究非创伤性股骨头坏死患者的中医证候及疼痛特点。方法:回顾性研究2016年12月至2018年12月于广州中医药大学第一附属医院确诊为非创伤性股骨头坏死并住院接受治疗的患者325例(428髋),收集所有患者的中医证候(包括舌体、舌质、舌苔、脉象、疼痛、寒热、纳眠、二便等)以及VAS评分,并对疼痛特点(疼痛部位、疼痛性质、疼痛是否固定、疼痛加重时间、疼痛持续的时间、疼痛诱发因素、疼痛缓解因素)进行统计学分析,总结其规律,应用Spearman检验对疼痛持续时间与VAS评分进行相关性分析。结果:非创伤性股骨头坏死患者的前15种证候依次为:舌紫暗、弦脉、痛有定处、夜间加重、苔薄白、胀痛、苔白腻、舌体胖大、刺痛、舌边有齿痕、滑脉、腰膝酸软、细脉、舌色黄、舌下络脉迂曲,经系统聚类分析后可归纳为气滞血瘀型、肾虚血瘀型、痰瘀互结型3类。胀痛、刺痛是较常见的疼痛性质,疼痛部位主要集中腹股沟区,疼痛部位固定,疼痛加重的时间不一,多数患者在在夜间加重,疼痛的缓解因素及诱发因素多种多样,多数患者在休息后疼痛会缓解,在行走后会加重。疼痛持续时间与VAS评分呈正相关。结论:血瘀证是非创伤性股骨头坏死过程的重要证候,患者疼痛持续时间与其疼痛的严重程度呈正相关关系。Objective:To study the characteristics of traditional Chinese medicine(TCM)syndromes and pain in patients with non-traumatic necrosis of the femoral head(NONFH).Methods:We prospectively documented 428 hips in 325 patients with NONFH from December 2016 to December 2018 in The First Affiliated Hospital of Guangzhou University of Chinese Medicine.TCM syndromes and VAS score were identified for all cases.Statistical analysis was performed on the characteristics of pain(location,nature,time,cause and remission).We used clustering analysis to concluded the TCM syndrome,and Spearman test was also used to analyze the correlation between the time of pain and VAS score.Results:The first 15 syndromes of patients with NONFH were listed in order as:tongue purple dark,string pulse,pain has a fixed place,aggravation at night,coating thin white,swelling pain,coating white greasy,tongue fat,tingling,tongue side tooth mark,smooth pulse,waist and knee soft,thin vein,tongue color yellow,the complex under the tongue is tortuous.After systematic cluster analysis,it can be classified into three types:qi stagnation and blood stasis,kidney deficiency and blood stasis,and phlegm and blood stasis.Bloated pain and tingling pain were common nature of pain,the main pain sites was the groin,the pain sites were fixed,the time the pain gets worse were different,most patients get worse at night,pain relief and inducing factors are various,most patients experience relief of pain after rest,gets worse after walking.The time of pain was positively correlated with VAS score.Conclusion:Blood stasis syndrome is an important syndrome in the process of NONFH.The time of pain was positively correlated with the severity of pain.

关 键 词：非创伤性股骨头坏死 股骨头坏死 中医证候 血瘀证 疼痛特点 

分 类 号：R274.9[医药卫生—中西医结合]