益肾复活通络汤联合髓芯减压术治疗早期气滞血瘀型股骨头坏死的效果观察

Observation on Efficacy of Yishenfuhuo Tongluo Decoction Combined with Medullary Core Decompression in the Treatment of Early Osteonecrosis of Femoral Head of Qi-Stagnation and Blood-Stasis Type

目的:探讨益肾复活通络汤联合髓芯减压术治疗早期气滞血瘀型股骨头坏死的效果及对患者血液流变学、骨代谢、凝血情况及血清转化生长因子β1(TGF-β1)、同型半胱氨酸(Hcy)水平的影响。方法:选取2018年1月至2019年2月天门市第一人民医院收治的早期气滞血瘀型股骨头坏死患者126例,采用随机数法将其分为治疗组和对照组,每组63例。治疗组患者采用益肾复活通络汤联合髓芯减压术治疗,对照组患者仅采用髓芯减压术治疗。观察患者髋关节Harris评分、血液流变学指标、骨代谢指标[血清Ⅰ型前胶原氨基端前肽(PⅠNP)、抗酒石酸酸性磷酸酶5b(TRACP-5b)和Ⅱ型胶原羧基端端肽(CTX-Ⅱ)]、凝血指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)和纤维蛋白原(FIB)]及血清TGF-β1、Hcy水平。结果:术后4周,两组患者髋关节Harris评分明显高于术前1周,且治疗组患者Harris评分明显高于对照组,差异均有统计学意义(P<0.05)。术后4周,两组患者全血高切黏度、全血低切黏度、血浆黏度及红细胞比容水平均较术前1周明显降低,且治疗组患者血液流变学指标水平明显低于对照组,差异均有统计学意义(P<0.05)。术后2、4周,两组患者血清PⅠNP、TRAP-5b水平较术前1周明显降低,而CTX-Ⅱ水平较术前1周明显升高;术后4周,治疗组患者PⅠNP、TRAP-5b水平明显低于对照组,差异均有统计学意义(P<0.05)。术后2、4周,两组患者血清PT、APTT及TT较术前1周明显延长,而FIB水平较术前1周明显降低;术后4周,治疗组患者PT、APTT明显长于对照组,FIB水平明显低于对照组,差异均有统计学意义(P<0.05)。术后2、4周,两组患者TGF-β1水平明显高于术前1周,Hcy水平明显低于术前1周;术后4周,治疗组患者Hcy水平明显低于对照组,差异均有统计学意义(P<0.05)。结论:益肾复活通络汤可以降低早期气滞血瘀型股骨头坏死患者术后血液黏稠度,缓解血液高凝状态,促进骨代谢,且降低Hcy水平,减轻炎症反应。

OBJECTIVE:To probe into the efficacy of Yishenfuhuo Tongluo decoction combined with medullary core decompression in the treatment of early osteonecrosis of femoral head of qi-stagnation and blood-stasis type and its effect on patients hemorheology,bone metabolism,blood coagulation,serum transforming growth factorβ1(TGF-β1)and homocysteine(Hcy).METHODS:Totally 126 patients with early osteonecrosis of femoral head of qi-stagnation and blood-stasis type admitted into the First People's Hospital of Tianmen from Jan.2018 to Feb.2019 were selected and divided into treatment group and control group via random number table,with 63 cases in each group.The treatment group was given Yishenfuhuo Tongluo decoction combined with medullary core decompression,while the control group was treated with medullary core decompressio alone.Harris score of hip joint,hemodynamic indices,bone metabolism indices[serum typeⅠprocollagen amino terminal propeptide(PⅠNP),tartrate-resistant acid phosphatase 5b(TRACP-5b)and typeⅡcarboxy terminal peptide of collagen(CTX-Ⅱ)],blood coagulation indices[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(FIB)],serum TGF-β1 and Hcy levels of both groups were observed.RESULTS:At 4 weeks after surgery,the Harris scores of hip joint of both groups were significantly higher than those of 1 week before surgery,the Harris score of hip joint of the treatment group were significantly higher than those of the control group,with statistically significant differences(P<0.05).At 4 weeks after surgery,the whole blood high-shear viscosity,whole blood low-shear viscosity,plasma viscosity and hematocrit level of both groups were significantly lower than those of 1 week before surgery,and the hemodynamic indices of treatment group were significantly lower than those of the control group,with statistically significant differences(P<0.05).At 2 weeks and 4 weeks after surgery,the serum PⅠNP and TRAP-5b levels of both groups were significantly lower than those of 1 week before surgery,while the CTX-Ⅱlevels had been significantly increased;at 4 weeks after surgery,the PⅠNP and TRAP-5b levels of treatment group were significantly lower than those of the control group,with statistically significant differences(P<0.05).At 2 weeks and 4 weeks after surgery,the serum PT,APTT and TT of both groups were significantly longer than those of 1 week before surgery,while the FIB levels had been significantly decreased;at 4 weeks after surgery,the PT and APTT of treatment group were significantly longer than those of the control group,while the FIB level was significantly lower than the control group,with statistically significant differences(P<0.05).At 2 weeks and 4 weeks after surgery,the TGF-β1 levels of both groups were significantly higher than those of 1 week before surgery,while the Hcy levels had been significantly decreased;at 4 weeks after surgery,the Hcy level of treatment group was significantly lower than that of the control group,with statistically significant differences(P<0.05).CONCLUSIONS:Yishenfuhuo Tongluo decoction can reduce the blood viscosity of patients with early osteonecrosis of femoral head of qi-stagnation and blood-stasis type after surgery,relieve blood hypercoagulation,promote bone metabolism,reduce Hcy level and alleviate inflammatory reaction.