针刺联合身痛逐瘀汤加减治疗早中期股骨头坏死临床研究

Clinical Study on Early and Middle Stage Necrosis of Femoral Head Necrosis Treated with Acupuncture Combined with Modified Generalized Pain Stasis-Expelling Decoction

目的:观察针刺联合身痛逐瘀汤加减治疗早中期股骨头坏死的临床疗效及对患者血液流变学、骨代谢指标、血脂水平的影响。方法:选取2021年1月至2022年4月郑州市骨科医院收治的早中期股骨头坏死患者124例,按照随机数字表法分为对照组和观察组,每组62例。对照组给予双氯芬酸钠肠溶片口服治疗,观察组给予针刺联合身痛逐瘀汤加减治疗。观察两组患者治疗前后Harris髋关节量表评分、SF-36量表评分、髋关节影像学评分。观察两组患者治疗前后血液流变学(全血高切黏度、全血中切黏度、全血低切黏度)、骨代谢指标[骨钙蛋白(osteocalcin, BGP)、抗酒石酸酸性磷酸酶异构体-5b(tartrate resistant acid phosphatase isomer-5b, TRACP-5b)、骨特异性碱性磷酸酶(bone specific alkaline phosphatase, BALP)]、血脂水平(载脂蛋白A、载脂蛋白B、总胆固醇)变化情况。结果:观察组有效率为98.4%,对照组有效率为80.6%,观察组有效率高于对照组,差异有统计学意义(P<0.05)。观察组治疗后Harris髋关节量表评分、髋关节影像学、SF-36评分高于对照组,差异有统计学意义(P<0.05)。观察组治疗后全血高切黏度、全血中切黏度、全血低切黏度低于对照组,载脂蛋白A、载脂蛋白B、总胆固醇水平低于对照组,BGP、TRACP-5b、BALP水平高于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率为1.6%,对照组不良反应发生率为19.4%,观察组低于对照组,差异有统计学意义(P<0.05)。结论:针刺联合身痛逐瘀汤加减治疗早中期股骨头坏死,可明显缓解患者的临床症状,改善其血液流变学指标、骨代谢指标及血脂水平,且不良反应发生率低。

Objective: To observe the clinical efficacy of acupuncture combined with Modified Generalized Pain Stasis-Expelling Decoction on early and middle stage femoral head necrosis(ONFH) and their influence on hemorheology, bone metabolism index and blood lipid level.Methods: A total of 124 patients with femoral head necrosis in the early and middle stages admitted to Zhengzhou Orthopedic Hospital from January 2021 to April 2022 were selected and divided into the control group and the observation group according to the random number table, with 62 cases in each group.The control group was treated with Diclofenac Sodium Enteric-Coated Tablets orally, while the observation group was treated with acupuncture combined with Modified Generalized Pain Stasis-Expelling Decoction.The Harris hip joint scale score, SF-36 scale score and hip imaging score before and after treatment were observed.The changes of blood rheology(including whole blood high shear viscosity, whole blood middle shear viscosity, and whole blood low shear viscosity),bone metabolism indexes [including bone calcin(BGP),tartrate resistant acid phosphatase isomer-5b(TRACP-5b),bone specific alkaline phosphatase(BALP)] blood lipid levels(includingapolipoprotein A,apolipoprotein B,total cholesterol) were observed.Results: The effective rate of the observation group was 98.4%,and that of the control group was 80.6%.The effective rate of the observation group was higher than that of the control group, with a statistically significant difference(P<0.05).The scores of Harris hip joint scale, hip imaging and SF-36 in the observation group were higher than those in the control group after treatment, with statistically significant differences(P<0.05).After treatment, the whole blood high shear viscosity, whole blood middle shear viscosity and whole blood low shear viscosity in the observation group were lower than those in the control group;the levels of apolipoprotein A,apolipoprotein B and total cholesterol were lower than those in the control group, and the levels of BGP,TRACP-5b and BALP were higher than those in the control group, with statistically significant differences(P<0.05).The incidence of adverse reactions in the observation group was 1.6%,and that in the control group was 19.4%.The incidence of adverse reactions in the observation group was lower than that in the control group, with a statistically significant difference(P<0.05).Conclusion: Acupuncture combined with Modified Generalized Pain Stasis-Expelling Decoction can significantly relieve the clinical symptoms of patients with early and middle femoral head necrosis, improve their blood rheology indicators, bone metabolism indicators and blood lipid levels, and the incidence of adverse reactions is low.