股骨头坏死中医证型与影像学特点的关联性研究

Correlation between characteristics of imaging and syndrome type of raditional Chinese medicine of osteonecrosis of femoral head

目的探讨股骨头坏死中医证型与影像学特点的相关性,为临床疗效评价提供客观依据。方法选择自2008年7月～2011年10月广州中医药大学第一附属医院髋关节病专科收治的股骨头坏死532例进行双髋关节正、蛙位X线片和MRI检查,提取影像学特征性表现,分析其与中医证型之间的关系。结果气滞血瘀型多见于创伤性患者,X线表现主要以"股骨头内硬化带不明显,头内密度不均"为特点(P<0.01);肾虚血瘀型多见于激素性患者,X线表现主要以"股骨头内存在连续硬化带"为特点(P<0.01),MRI所示骨髓水肿程度以0、2级为主(P<0.01);痰瘀蕴结型多见于酒精性患者,X线表现主要以"股骨头内存在硬化带+囊性改变"为特点(P<0.01),MRI所示骨髓水肿程度以1、3级为主(P<0.01)。结论建立股骨头坏死中医证型与影像学特征性表现之间的关联性,有利于指导临床治疗方法与评价指标的选择。

Objective To explore the relationship between the characteristics of imaging and syndrome type of traditional Chinese medicine of osteonecrosis of femoral head to supply the objective basis for evaluation of efficacy. Methods From July 2008 to October 2011, 532 patients suffered from femoral head necrosis from department of orthopaedics in First Affiliated Hospital of Guangzhou University of TCM were selected and underwent bilateral hip joint X-Ray and MRI, and the relationship between the characteristics of imaging and syndrome type of traditional Chinese medicine was analyzed. Results Qi stagnation and blood stasis type were a higher distribution proportion in traumatic femoral headnecrosis, No obvious sclerosis and uneven density of femoral head was the main characteristics of the X-ray （P 〈0.01 ）; Deficiency of the kidney and blood stash type was a higher distribution proportion in steroid-induced femoral head necrosis, Continuous sclerosis of femoral head was the main characteristics of the X-ray （P 〈0.01 ）, Zero/two grade bone marrow edema was the main characteristics of the MRI （P 〈0.01 ）. Phlegm and Stasis accumulation type was a higher distribution proportion in alcohol- induced femoral head necrosis, sclerosis and cystic of femoral head was the main characteristics of the X-ray （P 〈0.01）, One/three grade bone marrow edema was the main characteristics of the MBI （P 〈0.01）. Conclusion The present study establishes the relationship between the characteristics of imaging and syndrome type and of traditional Chinese medicine of osteonecrosis of femoral head to guide the method of the treatment and choose the evaluation index of the clinical efficacy.