身痛逐瘀汤治疗对股骨头坏死患者血液流变学的影响

Analysis of Shentong Zhuyu Decoction on Hemorheological Changes of Patients with Osteonecrosis of the Femoral Head from “Blood Stasis” Theory

目的:观察身痛逐瘀汤治疗对股骨头坏死的临床疗效,探讨其对血液流变学的影响。方法:选取2017年1月至2018年1月宝鸡市中心医院收治的股骨头坏死患者60例,按照随机数字表法分为对照组和观察组,每组30例。2组患者均接受股骨头坏死常规治疗,对照组在基础方案上加体外冲击波治疗,观察组在对照组治疗方案基础上应用身痛逐瘀汤治疗,1剂/d。2组均连续治疗8周,比较2组患者治疗前后生命质量评分(SF-36生命质量量表)、髋关节Harris评分、McMillan疼痛评估表、骨密度、骨钙素以及血液流变学的改变。结果:2组治疗后SF-36生命质量量表评分均较治疗前增加,差异有统计学意义(P <0. 05),其中观察组增加优于对照组,差异有统计学意义(P <0. 05); 2组治疗后髋关节Harris评分均较治疗前增加,差异有统计学意义(P <0. 05),其中观察组优于对照组,差异有统计学意义(P <0. 05); 2组治疗后FPSR疼痛评分均较治疗前下降,差异有统计学意义(P <0. 05),其中观察组下降的趋势更明显,差异有统计学意义(P <0. 05); 2组治疗后骨密度、骨钙素均较治疗前升高,差异有统计学意义(P <0. 05),其中观察组增加优于对照组,差异有统计学意义(P <0. 05);治疗后2组患者的全血低切还原黏度(LRV)、全血中切还原黏度(MRV)、全血高切还原黏度(HRV)、血浆黏度(PV)和纤维蛋白原(Fib)均较治疗前下降,其中观察组下降更为明显,差异有统计学意义(P <0. 05)。结论:身痛逐瘀汤对股骨头坏死有理想疗效,其作用机制可能与改善患者血液流变学有关。

Objective:To observe the clinical effects of Shentong Zhuyu Decoction on osteonecrosis of the femoral head,and to explore the effects of hemorheological changes.Methods:A total of 60 patients with osteonecrosis of the femoral head admitted to Baoji Central Hospital were randomly divided into control group and observation group,with 30 cases in each group.The two groups were treated with conventional treatment of osteonecrosis of femoral head.The control group was treated with extracorporeal shock wave therapy in addition to basic plan,on the basis of which the observation group was given Shentong Zhuyu Decoction 1 doses/day,and 200 mL decoction in the morning and evening.The two groups were treated continuously for 8 weeks.The quality of life score (SF-36 quality of life scale),hip joint Harris score,McMillan pain assessment table,bone density,osteocalcin and hemorheological indexes were compared before and after treatment in two groups.Results:The score of SF-36 quality of life in the two groups was increased (P<0.05),and the increase of the observation group was better than that of the control group (P<0.05):the Harris score of the hip joint was increased after treatment (P<0.05),and the observation group was superior to the control group (P<0.05):the FPS-R pain scores in the two groups were decreased than that before the treatment (P<0.05),and the decrease in the observation group was more obvious (P<0.05):the bone mineral density and osteocalcin in the two groups were increased after the treatment (P<0.05),and the observation group was better than the control group (P<0.05):after treatment,the whole blood low reduction viscosity (LRV),the whole blood middle reduction viscosity (MRV),and the whole blood high reduction viscosity (HRV),plasma viscosity (PV) and fibrinogen (Fib) were decreased than those before treatment,and the decrease in the observation group was more obvious (P<0.05).Conclusion:Shentong Zhuyu Decoction has an ideal effect on osteonecrosis of the femoral head,and its mechanism may be related to the improvement of hemorheology.