中医疗法治疗中晚期非创伤性股骨头坏死的研究

Study on the treatment with TCM therapy for middle and advanced nontraumatic femoral head necrosis

目的观察小针刀配合口服补骨片治疗中晚期非创伤性股骨头坏死的临床疗效。方法将寻求中医治疗的中晚期非创伤性股骨头坏死患者120例(骨坏死ARCO分期Ⅲ、Ⅳ期)随机分为2组,治疗组60例(60髋)给予6个月小针刀配合口服补骨片治疗,对照组60例(60髋)给予6个月电针配合口服补骨片治疗,2组均治疗随访1年,以患者治疗前后的疼痛视觉模拟评分(VAS评分)、髋关节功能评分(Harris评分)、股骨头影像学改变作为评价指标进行评判。结果 2组患者治疗随访1年时VAS评分均明显降低(P均<0.05),Harris评分均明显升高(P均<0.05),且治疗组VAS评分显著低于对照组(P<0.05),Harris评分显著高于对照组(P<0.05)。影像学检查显示,2组治疗前后股骨头形态、骨关节炎程度比较差异无统计学意义(P均>0.05);2组治疗后股骨头囊变面积明显缩小(P均<0.05),但2组间比较差异无统计学意义(P>0.05);治疗后2组影像稳定率比较差异无统计学意义(P>0.05),但治疗组临床总有效率明显高于对照组(P<0.05)。结论小针刀配合补骨片治疗中晚期非创伤性股骨头坏死在降低髋关节疼痛程度、改善髋关节功能方面较电针配合补骨片更有优势,可提高总体疗效。

Objective It is to observe the clinical effect of small needle-knife combined with oral Bugu tablet on middle and advanced non-traumatic femoral head necrosis. Methods 120 patients with middle and advanced non traumatic avascular necrosis （ osteonecrosis ARCO stage Ⅲ and Ⅳ ） looking for traditional Chinese medicine treatment were randomly divided into 2 groups, the treatment group （60 cases, 60 hips） were treated with small needle knife and Bugu tablet by oral administration for 6 months, the control group （60 cases, 60 hips） were treated with electric acpuncture and Bugu tablet by oral administration for 6 months. Both groups were followed up for one year, the curative effects were evaluated according to VAS scores, Harris scores and imaging changes of femoral head before and after treatment. Results At the end of follow up, VAS scores were significantly decreased while Harris scores were increased in both groups （P 〈0. 05 ） , and the VAS scores were lower while Harris scores were higher in the treatment group than those in the control group （P 〈 0.05）. Imaging examination showed that there was no significant difference in the femoral head form and osteoarthritis degree before and after treatment between the two groups （ P 〉 0.05 ）. After treatment, the area of femoral head was significantly reduced in both groups （P 〈0. 05 ） , but there was no significant difference between the two groups （ P 〉0. 05 ）. After treatment there was no statistically significant difference in imaging stabilization between the two groups （P 〉 0.05）, but the total clinical efficiency of the treatment group was significantly higher than that of the control group （P 〈 0.05）. Conclusion Small needle-knife combined with oral Bugu tablet have more advantages than electric acupuncture plus Bugu tablet in the improvements of pain and function of hip joint in the treatment of middle and advanced nontraumatic femoral head necrosis, its curative effect are better.