1926例股骨头坏死患者临床特点及中医证候分析

Clinical Characteristics and TCM Syndrome Analysis of 1926 Patients with Femoral Head Necrosis

目的:了解股骨头坏死患者的流行病学特征及中医证型分布特点,为股骨头坏死的诊断治疗提供研究资料。方法:对郑州中医骨伤病医院门诊及住院的股骨头坏死患者进行回顾性筛查分析,根据筛选标准及研究内容,制定调查记录表内容包括姓名、性别、年龄、病程、患侧、ARCO分期及中医证型。结果:共收集1926例患者,男1413例,女513例。958例患者有饮酒史,523例患者有激素应用史,超过1170例患者有吸烟史。患者来源河南省内1158例,其余768例分布全国各地。患者民族以汉族为主,占80.43%;职业以农民为主,占97.40%。患者平均发病年龄(44.58±11.75)岁,男性(43.45±11.03)岁,女性(47.44±13.15)岁,差异有统计学意义(t=-6.49,P=0.001)。患者病程最短3 d,最长30.30年;男性(18.20±11.50)个月,女性(26.14±12.45)个月,差异有统计学意义(Z=-6.07,P=0.001)。双侧坏死者1472例(76.43%),仅左侧坏死者238例(12.36%),仅右侧坏死者216例(15.14%)。共计3398髋,以ARCO分期,Ⅰ期25髋,Ⅱ期1004髋,Ⅲ期1359髋,Ⅳ期1010髋。中医证型:肝肾亏虚证684例(35.51%),湿热蕴结证241例(12.51%),痰瘀互结证317例(16.56%),寒湿痹阻证172例(8.93%),气滞血瘀证248例(12.88%),肾虚血瘀证264例(13.71%)。结论:股骨头坏死男性较女性发病率高,发病时间早,且病程较短。股骨头坏死双侧型较多,左侧与右侧之间无差异。临床ARCO分期以Ⅲ期最为多见,中医证型常见肝肾亏虚证,男女性别之间均无差异。

Objective:To understand the epidemiological characteristics of patients with femoral head necrosis and the distribution characteristics of TCM syndrome types,so as to provide research data for the diagnosis and treatment of femoral head necrosis.Methods:Retrospective screening analysis was carried out on the outpatients and inpatients of osteonecrosis of femoral head in Zhengzhou Hospital of Traditional Chinese Medicine.According to the screening criteria and research contents,a survey record was made,including name,sex,age,course of disease,affected side,ARCO stage and TCM syndrome type.Results:A total of 1926 patients were collected,including 1413 males and 513 females,with a statistically significant difference(P<0.05).958 patients had a history of drinking alcohol,523 patients had a history of hormone use,and more than 1170 patients had a history of smoking.1158 patients came from Henan Province,and the remaining(768 patients)were from the other areas of China.The ethnic group of the patients was Han,accounting for 80.43%;their occupation is mainly farmer,accounting for 97.40%.The average age of onset was(44.58±11.75)years,with male of(43.45±11.03)years and female of(47.44±13.15)years,and the difference was statistically significant(t=-6.49,P=0.000).The shortest duration of the disease was 3 days,and the longest was 30.30 years,with an average of(18.20±11.50)months for males and(26.14±12.45)months for females,with a statistically significant difference(Z=-6.07,P=0.000).1472 cases(76.43%)were bilateral bad dead,238 cases(12.36%)were left bad dead,and 216 cases(15.14%)were right bad dead.There were 3,398 hips in total.According to ARCO classification,there were 25 hips in stageⅠ,1004 hips in stageⅡ,1359 hips in stageⅢand 1010 hips in stageⅣ.For TCM syndrome types,there were 684 cases(35.51%)of liver and kidney deficiency syndrome,241 cases(12.51%)of damp heat accumulation syndrome,317 cases(16.56%)of phlegm and blood stasis syndrome,172 cases(8.93%)of cold dampness obstruction syndrome,248 cases(12.88%)of qi stagnation and blood stasis syndrome,and 264 cases(13.71%)of kidney deficiency and blood stasis syndrome.Conclusion:The incidence rate of femoral head necrosis in males is higher than that in females,with earlier onset time and the shorter course of disease.Necrosis of the femoral head is more bilateral,and there is no difference between the left side and the right side.The most common clinical ARCO stage is stageⅢ,and the common TCM syndrome type is liver and kidney deficiency.There is no difference between male and female.