郑州地区激素性股骨头坏死的临床特征和中医辨证论治情况

Clinical Features and Traditional Chinese Medicine Syndrome Differentiation and Treatment of Steroid-induced Osteonecrosis of Femoral Head in Zhengzhou Area

【目的】探讨河南省郑州地区激素性股骨头坏死(SONFH)患者的临床特征和中医辨证论治情况。【方法】利用郑州中医骨伤病医院股骨头坏死数据库,导出2016年12月至2019年8月确诊为SONFH的患者。收集所有患者的性别、年龄、职业、住院次数、基础疾病、中医证型、中医治法、方药、激素的种类、激素的应用途径、激素的总剂量、就诊时是否停药、疼痛时间、国际骨循环研究协会(ARCO)分期等,并对以上资料进行整理和统计分析。【结果】(1)基本情况方面:共纳入300例SONFH患者(523髋),其中,男179例(59.67%),女121例(40.33%),平均年龄(33.72±10.25)岁;单侧坏死77例(25.67%)77髋,双侧坏死223例(74.33%)446髋;ARCOⅡ期280髋,ARCOⅢ期243髋;平均疼痛时间(6.30±7.25)个月。(2)中医辨证论治方面:中医证型以肝肾亏虚证、肾虚血瘀证、脉络痹阻证为主,分别占全部患者的25.00%、20.67%、14.33%。中医治法方面,补肾活血法、补益肝肾法、补肾培元法最为常见,分别占全部患者的22.67%、18.00%、15.33%。方药应用方面,右归饮合桃红四物汤、补肾活血汤、大活络丸出现频数最多,分别占全部患者的21.67%、20.00%、17.33%。(3)基础疾病方面:其中风湿免疫疾病78例占26.00%,皮肤科疾病62例占20.67%,血液系统疾病和肾脏疾病各29例(各占9.67%),神经系统疾病27例(占9.00%),眼科疾病22例(占7.33%),呼吸疾病15例(占5.00%),肿瘤疾病9例(占3.00%),其他疾病29例(占9.67%)。(4)应用激素方面:按激素的种类分,应用频率最高的为甲强龙168次,其次分别为醋酸地塞米松158次、强的松79次、曲安奈德3次、布地奈德2次;按等量甲强龙换算,所有患者的平均激素使用剂量为(6532.43±2469.71)mg;63例(21.00%)患者在确诊时仍继续服用激素,237例(79.00%)患者在确诊时已停用激素;在确诊时已停用激素的患者中,有151例患者在停用激素后平均(3.06±2.01)个月诊断为股骨头坏死。【结论】郑州地区SONFH患者以中青年为主,且多为双侧发病。导致服用激素的基础疾病种类较多,甲强龙为应用较广泛的激素,其次为醋酸地塞米松,多数患者在停用激素后发现股骨头坏死。SONFH患者的中医证型以肾虚血瘀为主,以补肾活血为治疗大法,右归丸合桃红四物汤为治疗主方。

Objective To investigate the clinical features of steroid-induced osteonecrosis of femoral head(SONFH)patients in Zhengzhou area and to explore the traditional Chinese medicine(TCM)syndrome differentiation and treatment of SONFH.Methods Clinical data of the patients diagnosed as SONFH from December,2016 to August,2019 were extracted from the database of osteonecrosis of femoral head(ONFH)in Zhengzhou Traditional Chinese Medicine Hospital of Orthopedics.The clinical information of the included patients covered the gender,age,occupation,frequency of hospitalization,underlying diseases,TCM syndrome types,TCM therapy,prescriptions and medicine,types of steroid hormones,medication methods of hormone,total dose of steroid hormones,medication suspension or not at the visit time,duration of pain,and Association Research Circulation Osseous(ARCO)staging.And then the above data were sorted out and analyzed statistically.Results(1)Basic information:a total of 300 SONFH patients(523 hips)were included,including 179 males(59.67%)and 121 females(40.33%),with an average age of(33.72±10.25)years old.A total of 77 patients(25.67%)suffered from unilateral necrosis(77 hips),and 223 patients(74.33%)suffered from bilateral necrosis(446 hips).A total of 280 hips were classified into ARCOⅡand 243 hips were classified into ARCOⅢ.The mean duration of pain was(6.30±7.25)months.(2)TCM syndrome differentiation and treatment:the patients were mainly differentiated as liver and kidney deficiency syndrome,kidney deficiency and blood stasis syndrome,and vessels and collaterals obstruction syndrome,which accounted for 25.00%,20.67%and 14.33%,respectively.TCM therapy was predominated by tonifying kidney and activating blood method,tonifying liver and kidney method and tonifying kidney and cultivating the vital essence method,which accounted for 22.67%,18.00%and15.33%,respectively.The commonly-used prescriptions were Yougui Yin(Decoction for Replenishing Kidneyyang)plus Taohong Siwu Decoction,Bushen Huoxue Tang(Decoction for Tonifying Kidney and Activating Blood),and Da Huoluo Wan(Potent Bolus for Activating Collaterals),which accounted for 21.67%,20.00%and 17.33%,respectively.(3)Underlying diseases:of the included patients,78 cases(26.00%)had rheumatic diseases,62 cases(20.67%)had dermatological diseases,29 cases(9.67%)had blood system diseases,29 cases(9.67%)had kidney diseases,27 cases(9.00%)had nervous system diseases,22 cases(7.33%)had ophthalmic diseases,15 cases(5.00%)had respiratory diseases,9 cases(3.00%)had tumor,and 29 cases(9.67%)had other diseases.(4)Steroid hormone application:methylprednisolone had the highest application frequency of 168 times,followed by dexamethasone acetate(158 times),prednisone(79 times),triamcinolone acetonide(3 times)and budesonide(2 times).Converted by the equivalent dosage of methylprednisolone,the average dose of steroid hormones for all the patients was(6532.43±2469.71)mg.A total of 63 patients(21.00%)were still taking steroid hormones after confirmed diagnosis,and 237 patients(79.00%)had stopped taking steroid hormones before confirmed diagnosis.Among the patients suspending the steroid hormone use before the confirmed diagnosis,151 patients were diagnosed as ONFH after(3.06±2.01)months of steroid hormone withdrawal.Conclusion SONFH patients in Zhengzhou area are usually young and middle-aged,and most of the patients suffer from bilateral SONFH.There are many underlying diseases that lead to steroid hormone use,and methylprednisolone is the common type of steroid hormone for SONFH patients,followed by dexamethasone acetate.Most patients are diagnosed as ONFH after steroid hormone withdrawal.SONFH patients are usually differentiated as kidney deficiency and blood stasis syndrome,and can be mainly treated by the method of tonifying kidney and activating blood with Yougui Wan(Bollus for Replenishing Kidney-yang)plus Taohong Siwu Decoction.