中药结合髓芯减压植骨术治疗早期激素性股骨头坏死及疗效评价

Steroid-induced avascular necrosis of the femoral head in the early dialectical therapy and Clinical Evaluation

目的:应用中药结合髓芯减压植骨术来提高早期激素性股骨头坏死的疗效,并对其结果进行临床疗效和MRI评价。方法:选择自2004年8月至2009年8月间我院收治的已明确病因的早期激素性股骨头缺血性坏死(SANFH)病人60例,按ARCO分期将Ⅰ、Ⅱ期定为早期,随机分为对照组和治疗组各30例。对照组30例单纯采用活骨汤加减,每天1剂,分2次服用,连服6个月,其后中药制成丸剂口服6个月,连续共计12个月;治疗组30例,先采用股骨头髓芯减压术,再依据辩证分型中药汤剂内服,以活骨汤为基础方,同上加减补益肝肾之品,服用方法亦同上。所有患者每3个月复查X线片,分别于治疗后半年、1年、1.5年、2年随诊复查进行临床疗效评价,每年行MR检查1次。本次临床试验末次随访结果均采用治疗后1年的随访结果。结果:在临床症状体征、X线表现的改善方面,治疗组明显优于对照组,有极显著差异(P<0.01)。对两组治疗前、末次随访评分分别进行比较,末次随访的两组较治疗前均有极显著性差异(P<0.01)。在减轻骨内压、改善骨内循环、促进股骨头修复方面("线样征"、骨髓水肿),治疗组明显优于对照组,有统计学意义(P<0.05)。结论:①早期(Ⅰ、Ⅱ期)SANFH采用活骨汤加减治疗对改善临床症状及X线表现有一定疗效。②中药(活骨汤加减)结合髓芯减压的治疗方法,能同时改善股骨头内血液循环,减轻骨内压,并通过植骨提供必要的支撑,防止软骨塌陷,无论从临床疗效及X线疗效评分进行比较,还是从MRI骨髓水肿、线样征两方面进行评估,较之单用中药治疗的方法疗效更可靠。

Objective：Using Chinese medicine dialectical to improve the treatment of early necrosis of the femoral head,at the same time we hope to perfect the system of the efficacy of Evaluation.So the system will be more comprehensive.Methods：We chose 60 cases of Steroid-induced avascular necrosis of the femoral head（SANFH）patients Since August 2004 to August 2009,according to ARCO,ⅠandⅡtype was early necrosis of the femoral head,all patients were randomly divided into control group of 30 patients and the treatment group of 30 patients.The control group of 30 patients were used in the treatment of Huogutang,two times per day,continued for six months,at last six months used Chinese medicine pill.the treatment group have adopted myeloid core decompression of the femoral head,and then under the Chinese dialectical type,use huogutang and buyiganshen,the dosed medicine as the same.the treatment group have adopted myeloid core decompression of the femoral head,and then under the Chinese dialectical type,use huogutang and buyiganshen,the dosed medicine as the same.All patients would be chected X-ray every three months,six months after treatment,1,1.5,2-year follow-up would be reviewed of the clinical evaluation,and the annual inspection of MR.We chose the one-year follow-up results to be this clinical trial results.Results：In clinical symptoms,signs and X-ray performance improvements,the treatment group was significantly better than the control group（P0.01）.treatment compared with the controlled type and treatment type was a very significant differences（P0.01）.In the bone to reduce pressure and improvecirculation within the bone,and promote restoration of the femoral head（＂Line-sign＂,bone marrow edema）,the treatment group was better than the control group（P0.05）.Conclusion：Early（Ⅰ,Ⅱ）SANFH using Huogutangjiajian dialectical therapy have improved the clinical symptoms and X-ray changes of significant.Huogutang combined with myeloid core decompression of the femoral head can improve the blood supply of femoral head,compressed the pressure of bone.and then use bone graft supply sustentation of bone,prevent cartilage sink.compared with clinical effect、x ray effect、bone marrow edema and Line-sign of MRI effect,the clinical effect is significant than single use Chinese medicine.