骨蚀汤对股骨头坏死保髋术后髋关节影响的临床观察

Clinical observation on the effect of Gushi Decoction on hip joint after hip preserving surgery for femoral head necrosis

目的探讨自制骨蚀汤对早期股骨头缺血性坏死保髋术后髋关节影响的临床疗效。方法将90例早期股骨头坏死患者以就诊先后顺序随机分为观察组和对照组,观察组 48例,对照组42例。2组均行股骨头坏死病灶切除人工骨植入术,术后予常规预防感染、镇痛等治疗,观察组加用自制骨蚀汤,连续治疗3个月,随访至术后9个月,观察2组Harris评分、SF-36评分、血清BMP-2、TRACP-5b、VEGF的含量表达以及骨密度值的变化。结果观察组自术后3个月后Harris和SF-36评分明显高于对照组(P<0.05);2组血清BMP-2和VEGF含量均随时间增加而呈现不同程度的提升,与对照组相比,观察组提升更为明显且具有优势(P<0.05);观察组TRACP-5b含量在各时间稳定(P>0.05),与对照组TRACP-5b含量由高到低的趋势比较,差异有统计学意义(P<0.05);观察组骨密度值在术后6个月时开始升高,与对照组相比,差异有统计学意义(P<0.05)。结论早期股骨头缺血性坏死保髋术后应用自制骨蚀汤可提高患者的Harris、SF-36评分,增加患者血清中BMP-2、VEGF表达含量,减少TRACP-5b的升高,增加患区骨密度值。

Objective To investigate the clinical effect of self-made Gushi Decoction on hip joint after hip preserving surgery for early avascular necrosis of femoral head.Methods Ninety patients with early femoral head necrosis were randomly divided into observation group and control group according to the order of treatment,with 48 cases in the observation group and 42 cases in the control group.Both groups underwent femoral head necrosis lesion resection and artificial bone implantation.After the operation,they were treated with routine infection prevention and analgesia.The observation group was treated with self-made Gushi Decoction for 3 months and was given follow-up visits for 9 months after surgery.Harris score,SF-36 score,serum BMP-2,TRACP-5b,VEGF content expression and the changes in bone mineral density value were observed in the two groups.Results The Harris and SF-36 scores of the observation group were significantly higher than those of the control group 3 months later after surgery (P<0.05).The serum BMP-2 and VEGF levels of the two groups both rose with time,yet to different degrees.Compared with the control group,the rise of the observation group was more obvious and had advantages (P<0.05).The tracp-5b content of the observation group was stable at each time (P>0.05),and compared with the high-to-low trend of the control group,the difference was statistically significant (P<0.05).The bone mineral density value of the observation group began to rise 6 months later after surgery,and the difference was statistically significant compared with the control group (P<0.05).Conclusion The application of self-made Gushi Decoction after hip preserving surgery for early avascular necrosis of femoral head can improve the Harris and SF-36 scores,increase the expression of BMP-2 and VEGF in serum,slow down the rise of tracp-5b,and raise the bone mineral density of the affected area.