关于“血瘀证是股骨头坏死主要证候”的调查研究  

A survey of osteonecrosis of the femoral head presenting mainly with blood stasis syndrome

作　　者：沈莹姗 何晓铭[1] 赵雄 何炜 董庸伟 郑越生 李子祺[4] 何伟[4] 魏秋实[4] SHEN Yingshan;HE Xiaoming;ZHAO Xiong;HE Wei;DONG Yongwei;ZHENG Yuesheng;LI Ziqi;HE Wei;WEI Qiushi(The Third Clinical Medical College of Guangzhou University of Chinese Medicine,Guanghou 510006,Guangdong,China;Chengdu University of TCM,Chengdu 610075,Sichuan,China;Jinshazhou Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510168,Guangdong,China;The Institute of Traumatology and Orthopedics Affiliated to Guangzhou University of Chinese Medicine,Guangzhou 510240,Guangdong,China)

机构地区：[1]广州中医药大学第三临床医学院,广东广州510006 [2]成都中医药大学,四川成都610075 [3]广州中医药大学金沙洲医院,广东广州510168 [4]广州中医药大学骨伤科研究所,广东广州510240

出　　处：《中医正骨》2022年第4期25-29,32,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家自然科学基金项目(81904226,81873327);广东省自然科学基金项目(2017A030313698)。

摘　　要：目的:初步验证“血瘀证是股骨头坏死(osteonecrosis of the femoral head,ONFH)主要证候”这一理论。方法:①应用计算机检索中国知网、万方数据库、维普网1997年1月至2018年12月收录的所有有关ONFH血瘀证的中文文献,提取文献中关于ONFH血瘀证中医症状的描述,总结归纳ONFH血瘀证的中医症状。②根据文献研究总结归纳的ONFH血瘀证的中医症状,制定《“血瘀证”在股骨头坏死中的诊断标准调查问卷》,通过问卷调查选择其中专家意见协调度较高的中医症状,确定ONFH血瘀证判断标准。③从广州中医药大学第一附属医院关节骨科数据库系统V1.0,选取2018年4—12月在广州中医药大学第一附属医院治疗的ONFH患者的病例资料。选择其中具有完整中医证候信息的资料,按照拟定的ONFH血瘀证判断标准判定患者是否存在血瘀证症状。结果:①通过文献研究共总结出19条ONFH血瘀证的中医症状。②共有来自17个省、自治区、直辖市的99位专家(中医或中西医结合骨科专业)参与了问卷调查,问卷回收率100%。99位参与问卷调查的专家中,中级及以下职称48人、副高级职称28人、高级职称23人,工作年限(12.63±8.55)年。参与问卷调查的99位专家均同意“血瘀证是ONFH的主要证候”;19个血瘀证的中医症状中,“舌质紫暗”“痛如针刺,且痛点固定”“舌下络脉色深”的专家意见协调度较好、集中程度较高。③临床调查共纳入302例ONFH患者的病例资料,男203例、女99例,年龄(35.9±12.9)岁,激素性ONFH144例、酒精性ONFH97例、创伤性ONFH54例、特发性ONFH7例。按照问卷调查确定的ONFH血瘀证判断标准(3条中医症状符合其中1条),有血瘀证症状者共240例(79%),男155例、女85例;舌质紫暗者211例,舌下络脉色深者112例,疼痛如针刺且痛点固定者73例。结论:血瘀证是ONFH的主要证候,“舌质紫暗”“痛如针刺,且痛点固定”“舌下络�Objective:To preliminarily verify the theory of osteonecrosis of the femoral head(ONFH)presenting mainly with blood-stasis syndrome.Methods:All the Chinese articles about blood-stasis-type ONFH included from January 1997 to December 2018 were retrieved from China national knowledge internet, WanFang Database and VIP Database through computer.The descriptions of TCM symptoms of blood-stasis-type ONFH were extracted from the involved articles, and the TCM symptoms of blood-stasis-type ONFH were summarized and analysed.A questionnaire on the diagnostic criteria of blood-stasi-type ONFH was made according to the above-summarized TCM symptoms of blood-stasis-type ONFH.The TCM symptoms with high coordination degree of expert opinions were obtained through the questionnaire survey for determining the judgment criteria of blood-stasis-type ONFH.The medical records of ONFH patients who were treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from April 2018 to December 2018 were screened out from database system V1.0 of the department of joint surgery of the First Affiliated Hospital of Guangzhou University of Chinese Medicine,and the medical records containing complete information of TCM syndrome were selected out for judging whether the ONFH patients had blood-stasis syndrome according to above judgment criteria. Results: Nineteen TCM symptoms of blood-stasis-type ONFH were obtained through analyzing on the involved articles. Ninety-nine experts,including 48 intermediate and below professional titles,28associate senior professional titles and 23 senior professional titles,came from 17 provinces,autonomous regions and direct-controlled municipality and participated in the questionnaire survey( 100% response rate),and their current working experiences were 12. 63 ± 8. 55years. The theory of ONFH presenting mainly with blood-stasis syndrome was recognised by all the involved experts,and the experts had good coordination and a high degree of concentration on dark purple tongue,fixed piercin

关 键 词：股骨头坏死 血瘀 问卷调查 

分 类 号：R274.9[医药卫生—中西医结合]