枢经针刀治疗ARCOⅠ、Ⅱ期股骨头坏死的临床效果

Clinical effect on treatment of ARCO stageⅠandⅡfemoral head necrosis with pivot channel needleknife

目的观察枢经针刀治疗ARCOⅠ、Ⅱ期股骨头坏死(ONFH)患者的临床效果。方法选取2019年6月至2020年12月广西中医药大学第一附属医院康复医学科收治的ONFH患者60例,采用随机数字表法将其分为治疗组和对照组,各30例。治疗组予以枢经针刀联合恒古骨伤愈合剂治疗,对照组采用普通针刺联合恒古骨伤愈合剂治疗,共治疗3个月,在治疗结束后第12个月进行随访。观察指标为Harris髋关节评分(HHS)、视觉模拟评分法(VAS)评分和生存质量量表(SF-36)评分。结果治疗组中2例患者脱落,对照组中1例脱落,剔除此3例患者,最终对57例患者进行结果分析。治疗组临床疗效优于对照组,差异有统计学意义(P<0.05)。VAS评分组间比较、时间点比较及交互作用差异均有统计学意义(P<0.05);进一步两两比较,组内比较:两组治疗后、随访时,VAS评分较治疗前降低(P<0.05);组间比较:治疗后及随访时,治疗组VAS评分低于对照组,差异有统计学意义(P<0.05)。HHS总分及功能性活动和畸形评分组间比较、时间点比较及交互作用差异均有统计学意义(P<0.05);疼痛评分时间点比较及交互作用差异均有统计学意义(P<0.05),组间比较无统计学意义(P>0.05);关节活动评分交互作用差异有统计学意义(P<0.05)。进一步两两比较,组内比较:两组治疗后、随访时,HHS总分、疼痛、功能性活动、关节活动评分均高于治疗前,差异有统计学意义(P<0.05),治疗组畸形评分治疗后高于治疗前(P<0.05),对照组畸形评分治疗前后差异无统计学意义(P>0.05);组间比较:治疗后和随访时,治疗组HHS总分、功能性活动和畸形评分均高于对照组,差异有统计学意义(P<0.05)。两组治疗后的生存质量评分均高于治疗前,差异有统计学意义(P<0.05);治疗后,治疗组生理功能、躯体疼痛、一般健康状况、精力、社会功能、精神健康评分高于对照组,差异有统计学意义(P<0.05);两组生理职能、情感职能评分比较,差异无统计学意义(P>0.05)。结论枢经针刀、普通针刺治疗ARCOⅠ、Ⅱ期ONFH患者都有效果,但在改善程度上枢经针刀优于普通针刺。

Objective To observe the clinical effect on treatment of ARCO stageⅠandⅡostecnecrosis of the femoral head(ONFH)with pivot channel needleknife.Methods A total of 60 patients with ONFH were selected from the Department of Rehabilitation Medicine,the First Affiliated Hospital of Guangxi University of Chinese Medicine from September 2019 to December 2020,and they were divided into treatment group and control group,with 30 patients in each group.The treatment group was treated with pivot channel needleknife combined with Osteoking,and the control group was treated with common acupuncture combined with Osteoking for three months,with a follow-up visit at the 12th month after the end of treatment.The outcome measures were Harris hip score(HHS),visual analogue scale(VAS)and quality of life scale(short form,SF-36).Results Shedding occurred in two patients in the treatment group;one case fell out in the control group and those cases were excluded,resulting in a final outcome analysis of 57 cases.The clinical effect of the treatment group was better than that of the control group,and the difference was statistically significant(P<0.05).Comparison between groups,comparison at time point and interaction of VAS were statistically significant(P<0.05).Further pair comparison and intra-group comparison:VAS scores of the two groups were lower after treatment and at follow-up than before treatment(P<0.05);comparison between groups:after treatment and at follow-up,VAS score of the treatment group was lower than that of the control group,the differences were statistically significant(P<0.05).There were significant differences in the total score of HHS,functional activities,and deformities among groups,time points and interaction(P<0.05).The time point comparison and interaction differences of pain score were statistically significant(P<0.05),but there was no statistical significance between groups(P>0.05);the interaction of joint activcty score was statistically significant(P<0.05).Further pairwise comparison and intra-group comparison:after treatment and at follow-up,the total score of HHS,pain,functional activity and joint activity scores of the two groups were higher than before treatment,the differences were statistically significant(P<0.05),the deformity score of the treatment group was higher than before treatment(P<0.05),the deformity score of the control group was not statistically significant before and after treatment(P>0.05).Comparison between groups:after treatment and at follow-up,the total score of HHS,functional activities and malformation scores in the treatment group were higher than those in the control group,the differences were statistically significant(P<0.05).The quality of life scores of the two groups were higher after treatment than before treatment,the differences were statistically significant(P<0.05).After treatment,the scores of physiological function,physical pain,general health status,energy,social function,and mental health in the treatment group were higher than those in the control group,and the differences were statistically significant(treatment group).There was no significant difference in physiological function and emotional function scores between the two groups(P>0.05).Conclusion It is effective to treat ONFH patients with ARCO stagesⅠandⅡwith pivot channel needleknife and common acupuncture,but the pivot channel needleknife is superior to the common acupuncture in the degree of improvement.