复方生脉成骨胶囊防治激素性股骨头坏死的MRI评价

Evaluation on the Effect of Compound Shengmai Chenggu Capsule in the Prevention and Treatment of Steroid-induced Osteonecrosis of Femoral Head Based on Magnetic Resonance Imaging

目的以核磁共振(MRI)评价复方生脉成骨胶囊防治激素性股骨头坏死(SIONFH)的临床疗效。方法选取符合诊断及中医药治疗标准的SIONFH患者37例,依据ARCO分期将患者分为3组,并予复方生脉成骨胶囊口服,均治疗3个月。治疗前后,运用Mimics和ImageJ比较3组的MRI三维体表面积和承重面参数,了解及比较MRI在诊断股骨头坏死的骨微环境特征。结果Ⅰ期患者总有效率(治愈+好转)100%,Ⅱ期患者总有效率94.11%,Ⅲ期患者总有效率87.5%;治疗后3组患者的Harris髋关节评分较治疗前均明显降低(P<0.05);治疗前,坏死区、硬化区体积、病灶表面积随ARCO分期升高而增加;治疗前与治疗后相比,各组坏死区体积均相对较少(P<0.05),硬化区体积均增加(P<0.05);各组体积比比较,Ⅲ期体积比前2组有较大增加(P<0.01);与治疗前相比,Ⅱ期治疗后体积比明显增加(P<0.01)。治疗前承重坏死区、硬化区面积随ARCO分期升高而增加(P<0.05);与治疗前相比,治疗后各组坏死区面积均相对较少(P<0.05),硬化区面积均增加(P<0.05)。结论复方生脉成骨胶囊能较大程度促进SIONFH修复,硬化区相对增加且坏死区相对减少,另外MRI成像具有多平面多角度展示股骨头坏死坏死区和硬化区的改变,并能更早地明确骨微环境的损伤情况,具有相当重要的临床实用价值。

Objective To evaluate the effect of compound Shengmai Chenggu capsule on prevention and treatment of steroid-induced osteonecrosis of femoral head(SIONFH)by magnetic resonance imaging(MRI),and to observe the clinical effect of compound neonatal osteoporosis capsule on necrosis repair.Methods 37 patients with SIONFH were selected according to the criteria of diagnosis and accepted treatment.The patients were divided into three groups according to ARCO staging and treated with compound Shengmai Chenggu capsule for 3 months.Before and after treatment,Mimics and Image J were used to compare the three-dimensional volume,surface area and bearing surface parameters of the three groups.The bone microenvironment of the femoral head was diagnosed and compared.Results The total effective rate was 100%in stageⅠ,94.11%in stageⅡand 87.5%in stageⅢ.The Harris hip score of the three groups was significantly lower than that before treatment(P<0.05).The volume of necrotic area(Vna),harden area(Vha)and surface area of focal zone(Sfz)increased with the enhancement of ARCO staging.Before and after treatment,the Vna of each group was relatively lower(P<0.05),while Vha decreased(P<0.01).Compared with the previous two groups,the ratio of Vha and Vna of theⅢstage groups was significantly higher(P<0.05).The ratio of theⅡstage group enhanced significantly after treatment(P<0.01).Before treatment,necrotic area underweight(Anau)and necrotic area underweight(Anau)increased with the improvement of ARCO stage(P<0.05).Comparing before and after treatment,Anau in each group was relatively low(P<0.05),and Anau increased with the increase of ARCO stage(P<0.05).Conclusion Compound Shengmai Chenggu capsule can promote the necrotic hearling of SIONFH,increase of harden area and reduce necrotic area.In addition,MRI imaging has multiple changes on measuring SIONFH.There is a very vital clinical value for the bone microenvironment damage.