桃红四物汤加减对股骨头坏死临床疗效及部分机制探讨

Exploration on Clinical Efficacy and Partial Mechanism of Modified Taohong Siwu Decoction in Osteonecrosis of the Femoral Head

目的:分析桃红四物汤加减辨证和单纯西医治疗股骨头坏死临床疗效,探讨中医药治疗股骨头坏死作用机制,以期为股骨头坏死治疗方案选择提供依据。方法:选取2017年4月至2018年4月宝鸡市中医医院收治股骨头坏死患者78例作为研究对象,按照随机数字表法将患者分为对照组和观察组,每组39例。对照组予髓芯减压手术治疗,术后常规预防感染、改善微循环,促进血循环等对症治疗。观察组在对照组基础上加用桃红四物汤加减辨证治疗,2组均同时治疗2周。观察2组患者治疗前、治疗末在血液流变学、红细胞聚集变化情况并比较;观察治疗前、治疗末Harris髋关节功能评分变化并比较;治疗过程中进行不良反应观察并比较;治疗末进行疗效比较。结果:1)2组患者治疗前全血高切、全血低切、全血中切、血浆黏度、红细胞聚集指数比较,差异无统计学意义(P>0.05),治疗末对照组较治疗前比较,差异无统计学意义(P>0.05)。治疗末观察组以上指标较治疗前显著下降(P<0.05),治疗末观察组患者以上指标显著低于对照组(P<0.05)。2)2组患者治疗前红细胞聚集程度狗情情况比较,差异无统计学意义(P>0.05),完成治疗后,2组患者红细胞无聚集率均较治疗前明显上升,且观察组明显高于对照组(P<0.05);3)2组患者治疗前Harris评分功能、疼痛、髋关节活动范围、下肢畸形和总分比较,差异无统计学意义(P>0.05),治疗末以上指标2组较治疗前均显著升高(P<0.05),治疗末观察组患者以上指标显著高于对照组(P<0.05)。4)完成治疗后观察组患者治愈率、总有效率明显高于对照组(P<0.05)。5)2组不良反应发生率上比较,差异无统计学意义(P>0.05)。结论:桃红四物汤加减能提高股骨头坏死疗效,改善股骨头微循环,提高髋关节功能,且不良反应少,能提高患者生命质量。

Objective: To analyze the clinical efficacy of Modified Taohong Siwu Decoction in the syndrome differentiation and treatment of osteonecrosis of the femoral head(ONFH)and that of western medicine alone,and to explore the mechanism of traditional Chinese medicine(TCM)in the treatment of ONFH,so as to provide evidence for the treatment selection of ONFH. Methods: A total of 78 ONFH cases admitted in the Baoji Traditional Chinese Medicine Hospital from April 2017 to April 2018 were selected as research objects.The patients were divided into a control group(39 cases)and an observation group(39 cases)by the method of random number table.The control group was treated with core decompression,and postoperative symptomatic treatment such as prevention of infection,improvement of microcirculation and promotion of blood circulation were given.On the treatment basis of the control group,the observation group was added with modified Taohong Siwu Decoction for syndrome differentiation and treatment.The 2 groups were treated for 2 weeks.Changes of hemorheology and erythrocyte aggregation before and after the treatment were observed and compared between the 2 groups;changes of Harris hip function score before and after the treatment were observed and compared;adverse reactions during the treatment were observed and compared;and the efficacy was compared at the end of treatment. Results: 1)Before the treatment,there was no significant difference in whole blood high-shear,whole blood low-shear,whole blood middle-shear,and plasma viscosities between the 2 groups( P >0.05).There was no significant difference before and after the treatment in the control group( P >0.05).The above indexes at the end of the treatment in the observation group were significantly lower than those before the treatment( P <0.05),and those at the end of the treatment in the observation group were significantly lower than those in the control group( P <0.05).2)There was no significant difference in the degree of erythrocyte aggregation between the 2 groups before the treatment( P >0.05).After the treatment,the rates of erythrocyte non-aggregation in both groups were significantly higher than those before the treatment,and that in the observation group was significantly higher than that in the control group( P >0.05).3)There was no significant difference in the Harris function scores of pain,hip joint motion range and lower limb deformity and the total scores between the 2 groups before the treatment( P >0.05).The above indexes at the end of the treatment in the 2 groups were significantly higher than those before the treatment( P <0.05).The above indexes at the end of the treatment in the observation group were significantly higher than those in the control group( P <0.05).4)After the treatment,the cure rate and total effective rate in the observation group were significantly higher than those in the control group( P < 0.05).5)There was no significant difference in the incidence of adverse reactions between the 2 groups( P >0.05). Conclusion: Modified Taohong Siwu Decoction can improve the efficacy in OFHN,improve the microcirculation of femoral head,improve the function of hip joint,and improve the life quality of patients,with few adverse reactions.