基于“态靶结合”理论探讨股骨头坏死囊性变的辨治思路

Discussion on Syndrome Differentiation and Treatment of Cystic Degeneration in Osteonecrosis of Femoral Head Based on “Status-Target” Theory

“态靶结合”是切合中医精准化的一种辨治模式,“态”是疾病发展到某一阶段的核心病机的归纳,属于宏观范畴;“靶”是参照西医的框架,基于“态”去寻找疾病的靶点、靶方、靶药,属于微观范畴。“坏死→修复→塌陷→骨关节炎”是多数股骨头坏死患者遵循的自然病理过程,此过程受宏观因素(全身情况、基础疾病、髋关节的生物力学环境)与微观因素(细胞代谢异常、股骨头局部的血运)的影响。塌陷与否对于股骨头坏死的预后具有关键性影响,认识塌陷与修复的关系,找出影响股骨头塌陷与骨修复的宏观、微观因素并进行干预至关重要。囊性变与股骨头坏死局部的软骨下骨折、“新月征”密切相关,囊性变的出现有可能导致髋关节局部的生物力学性能下降,增加塌陷的风险。前期研究发现血瘀证贯穿股骨头坏死的病理进程,根据“态靶辨证”理论,血瘀态是股骨头坏死的一种“态”,而囊性变可作为股骨头坏死的靶。文章基于“态靶结合”理论,探讨股骨头坏死囊性变的辨治思路,以期为中医药精准化治疗股骨头坏死提供更多参考。

“Combination of state and target”is a differentiation and treatment mode suitable for TCM precision.“State”is the summary of the core pathogenesis of a certain stage of disease development,which belongs to the macro category.“Target”refers to the framework of western medicine,based on“state”to find out the target of disease,target prescription,target drug,belonging to the micro category.“Necrosis-repair-collapse-osteoarthritis”is the natural pathological process followed by most patients with osteonecrosis of the femoral head which is influenced by macro factors(systemic condition,basic disease,biomechanical environment of hip joint)and micro factors(abnormal cell metabolism,local blood supply of femoral head).Collapse or not has a key influence on the prognosis of femoral head necrosis.It is very important to understand the relationship between collapse and repair,find out the macro and micro factors that affect the collapse and repair of femoral head,and intervene.Cystic change is closely related to the subchondral fracture and“crescent sign”of local femoral head necrosis.The occurrence of cystic change may lead to the decrease of local biomechanical properties of hip joint and increase the risk of collapse.Previous studies have found that the blood stasis syndrome is in the pathological process of femoral head necrosis.According to the theory of“state-target syndrome differentiation”,the blood stasis syndrome is a“state”of femoral head necrosis,and cystic change can be used as the target of femoral head necrosis.Based on the theory of“combination of state and target”,this paper discussed the identification and treatment of cystic degeneration of femoral head,so as to provide more references for TCM precise treatment of femoral head necrosis.