3种髋关节疾病早期“异病同证”的证素特征和证候分布规律研究  

Study on the characteristics of pattern elements and the distribution of patterns of three kinds of early hip joint diseases with"different diseases with the same pattern"

作　　者：周峻 李文龙 梁志 颜炎 宓保宏 王荣田 陈卫衡 ZHOU Jun;LI Wenlong;LIANG Zhi;YAN Yan;MI Baohong;WANG Rongtian;CHEN Weiheng(Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China;Engineering Research Center of Chinese Orthopaedics and Sports Rehabilitation Artificial Intelligent,Ministry of Education,Beijing 100029,China)

机构地区：[1]北京中医药大学第三附属医院,北京100029 [2]中医骨伤治疗与运动康复智能化教育部工程研究中心

出　　处：《北京中医药大学学报》2024年第3期417-428,共12页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金重点项目(No.82030122);国家自然科学基金面上项目(No.81973888,No.81473695)。

摘　　要：目的 分析股骨头坏死、髋骨关节炎、类风湿髋关节炎早期证素特征、证候分布规律,为慢性骨病“异病同证”提供理论依据。方法 采用横断面调查的研究方法,选择2020年6月—2022年6月在北京中医药大学第三附属医院微创关节科、创伤关节科、风湿免疫科就诊的股骨头坏死国际骨微循环研究协会Ⅰ~Ⅱ期、髋骨关节炎Kellgren-LawrenceⅠ~Ⅱ级、类风湿髋关节炎急性期或亚急性期的患者,采用本团队前期制定的“病例报告表-中医证候表现量表”,收集中医证候信息,录入Excel 2020建立数据库,采用SPSS 20.0软件进行因子分析、聚类分析,提取病性、病位等证素信息,总结3种髋关节疾病早期证素特征、证候类型分布规律及其异同点。结果 本研究共纳入410例患者,其中,股骨头坏死患者150例、髋骨关节炎患者160例、类风湿髋关节炎患者100例。股骨头坏死病性证素包括痰(湿)、血瘀、阳虚、精亏、气虚;证候类型初步分为经脉痹阻证(43.33%)、痰瘀阻络证(38.00%)、肝肾亏虚证(12.00%)、肾精不足证(6.67%)4类。髋骨关节炎病性证素包括痰(湿)、血瘀、气虚、精亏、阳虚、寒(湿);证候类型初步分为脾肾亏虚证(37.50%)、经脉痹阻证(26.87%)、寒湿痹阻证(18.75%)、痰瘀痹阻证(9.38%)、肝肾亏虚证(7.50%)5类。类风湿髋关节炎病性证素包括痰(湿)、血瘀、气虚、阴阳两虚、寒(湿)、精亏;证候类型初步分为痰瘀痹阻证(34.00%)、寒湿痹阻证(28.00%)、瘀血阻络证(23.00%)、肝肾不足证(15.00%)4类。整体分析3种髋关节疾病,排在前5位的证候表现为髋关节痛(96.59%)、压痛(93.90%)、固定痛(87.56%)、关节沉重(85.37%)、下肢酸楚(75.37%);病性证素包括痰(湿)、血瘀、气虚等;证候类型初步分为痰瘀阻络证(33.17%)、经脉痹阻证(31.95%)、寒湿痹阻证(21.46%)、肝肾不足证(7.32%)、脾肾亏虚证(6.10%)5类;3种疾病早期相同的证候表现�Objective To analyze the characteristics of pattern elements and the distribution of patterns of femoral head necrosis,hip osteoarthritis,and hip rheumatoid arthritis,in order to provide a theoretical basis for the"different diseases with the same pattern"of chronic bone diseases.Methods A cross⁃sectional survey was conducted to select patients with femoral head necrosis Association Research Circulation OsseousⅠ-Ⅱstages,hip osteoarthritis Kellgren&LawrenceⅠ-Ⅱstages,and acute or subacute hip rheumatoid arthritis who visited the Minimally Invasive Arthrology Department,Traumatology Department,and Rheumatology and Immunology Department of Beijing University of Chinese Medicine Third Affiliated Hospital from June 2020 to June 2022.The"case report form-traditional Chinese medicine pattern manifestation scale"previously developed by our team was used to collect the pattern manifestations,which were included into an Excel 2020 spreadsheet to establish a database.SPSS 20.0 software was used for factor analysis and cluster analysis to extract pattern element information,such as disease nature and location,in order to summarize the characteristics of pattern elements,the distribution of patterns,and the similarities and differences of the three kinds of early hip joint diseases.Results A total of 410 patients were included,including 150 patients with femoral head necrosis,160 patients with hip osteoarthritis,and 100 patients with hip rheumatoid arthritis.The pattern elements of the disease nature of femoral head necrosis include phlegm(dampness),blood stasis,yang deficiency,essence deficiency,and qi deficiency.The pattern types were initially divided into four categories:syndrome of meridian obstruction(43.33%),syndrome of phlegm and blood stasis blocking collaterals(38.00%),syndrome of liver and kidney deficiency(12.00%),and syndrome of kidney essence deficiency(6.67%).The pattern elements of the disease nature of hip osteoarthritis include phlegm(dampness),blood stasis,qi deficiency,essence deficiency,yang defi

关 键 词：股骨头坏死 髋骨关节炎 类风湿髋关节炎 证素 证候 

分 类 号：R274.9[医药卫生—中西医结合]