骨复生治疗股骨头坏死的临床疗效及其对血液流变学的影响

Effect of Gufusheng on Clinical Efficacy and Hemorheology of Patients with Osteonecrosis

目的通过对股骨头坏死患者治疗前后临床各疗效指标的评价,结合血液流变学指标的检测分析,探讨中药制剂骨复生对早中期股骨头坏死患者的临床疗效及血液流变学的影响,探讨其可能作用机理,为本方的临床合理应用提供依据。方法68例股骨头坏死患者按就诊顺序分为治疗组和对照组,每组各34例,治疗组给予中药骨复生治疗,对照组给予阿仑膦酸钠片治疗,连续服用3个月后观察各组患者治疗前后患髋关节疼痛(静息痛和活动痛)VAS评分、髋关节Harris评分以及血液流变学相关指标的变化。结果①两组治疗后的患髋关节静息和活动时疼痛VAS评分均低于治疗前,具有显著性差异(P<0.05);且治疗组VAS评分降低更明显,组间比较差异具有统计学意义(P<0.05)。②两组治疗后的髋关节Harris各项(疼痛、日常活动和行走能力、畸形、关节活动度)评分和总评分均高于治疗前,具有统计学意义(P<0.05);组间比较,治疗组Harris各项评分和总评分均稍高于对照组,差异具有统计学意义(P<0.05)。③治疗后两组患者的全血黏度200(1/s)、红细胞变形指数(erythrocyte deformation index TK,TK)、血浆纤维蛋白原(Fibrinogen b,Fb)、血沉方程K值(Erythrocyte sedimentation rate-K,ESR-K)、红细胞聚集指数(The red cell aggregation index,RE)、卡松黏度(Casson viscosity c,ηc)、高切相对黏度(High shear relative viscosity,HRV)、低切相对黏度(Low Shear Relative Viscosity,LRV)、血浆粘度(Casson viscosity p,ηp)、血沉(Erythrocyte sedimentation rate,ESR)、红细胞电泳时间(Erythrocyte electrophoresis time,EPT)均较治疗前下降(P<0.05),且治疗组下降更明显,组间比较差异具有统计学意义(P<0.05);但治疗后的全血黏度3(1/s)、30(1/s)、红细胞压积(Hematocut,HCT)、卡松屈服应力(Casson Yield Stress c,γc)、红细胞刚性指数(Index Of Rigidity Of Erythrocyte,IR)、平均网织红细胞体积(Mean reticulocyte volume,MRV)无明显变化(P>0.05)。结论骨复生能缓解早中期股骨头坏死患者的疼痛、改善关节活动受限等不适症状,对患者血液流变学的部分指标也有一定的改善作用。

Objective Combining with the detection and analysis of hemorheology indexes,to evaluate the clinical curative effect and hemorheology of osteonecrosis before and after treatment to explore the clinical effect of Gufusheng and hemorheology of patients in the early and middle stage as well as its possible mechanism,providing the basis for the clinical application of the prescription.Methods 68 patients with osteonecrosis were divided into treatment group and control group according to their registration time with 34 cases in each group.The treatment group was treated with Chinese medicine Gufusheng,and the control group was treated with alendronate sodium tablets.The VAS score of hip joint pain(rest pain and activity pain),Harris score of hip joint and hemorheology related indexes were observed before and after treatment in each group.Result①The VAS scores of hip joint pain at rest and activity in the two groups after treatment were lower than those before treatment with significant difference(P<0.05);The VAS score of the treatment group decreased more significantly,and the difference between the two groups was statistically significant(P<0.05).②Harris scores and total scores of hip joint(pain,daily activities and walking ability,deformity,joint range of motion)and total scores of the two groups after treatment were higher than those before treatment with statistical significance(P<0.05).The Harris scores and total scores in the treatment group were slightly higher than those in the control group with statistical significance(P<0.05).③After treatment,the whole blood viscosity 200(1/s),TK,FB,ESR-K,re(erythrocyte aggregation index),HC(Casson viscosity),HRV,LRV,ηP,ESR,EPT(erythrocyte electrophoresis time)of the two groups were decreased after treatment(P<0.05),and the decrease in the treatment group was more obvious,the difference between the two groups was statistically significant(P<0.05).However,the whole blood viscosity 3(1/s),30(1/s),HCT,γC,IR,MRV had no significant changes after treatment(P>0.05).Conclusion Gufusheng can relieve the pain of patients with avascular necrosis of the femoral head in the early and middle stage,improve the joint activity limitation and other discomfort symptoms,and also can improve some indexes of hemorheology.