消炎止痛膏联合钻孔减压自体髂骨松质骨打压植骨治疗早期股骨头坏死的效果观察

Effect of Xiaoyan Zhitong Ointment combined with drilling decompression and autogenous iliac cancellous bone grafting on early osteonecrosis of the femoral head.

目的分析消炎止痛膏联合钻孔减压自体髂骨松质骨打压植骨治疗早期股骨头坏死的效果。方法前瞻性选取2019年1月至2020年12月唐山市第二医院收治的86例早期股骨头坏死患者作为研究对象。按随机数字表法分为两组,每组各43例。对照组采用钻孔减压自体髂骨松质骨打压植骨治疗,观察组采用消炎止痛膏联合钻孔减压自体髂骨松质骨打压植骨治疗。观察并比较两组股骨头坏死的治疗效果、治疗前后Harris髋关节功能评分、血浆中枢神经特异性蛋白S-100B及神经元特异性烯醇化酶(NSE)水平及不良反应发生情况,并进行统计学分析。结果治疗后3、6、12个月,两组Harris髋关节功能评分均较治疗前显著升高,且观察组治疗后的Harris髋关节功能评分分别为(77.23±7.65)、(83.84±6.69)、(86.71±6.15)分,均高于对照组[(72.91±8.12)、(79.31±6.25)、(83.22±6.33)分],差异均有统计意义(P<0.05)。治疗后4、8、12周,两组血浆S-100B及NSE水平均较治疗前降低,且观察组治疗后血浆S-100B分别为(75.21±6.66)、(72.85±6.05)、(70.55±5.93)ng/mL,NSE水平分别为(15.41±3.96)、(13.73±3.31)、(12.35±2.87)ng/mL,显著低于对照组[S-100B:(78.94±7.11)、(76.33±6.31)、(74.44±6.22)ng/mL;NSE:(17.19±4.13)、(15.86±3.97)、(14.03±3.61)ng/mL],差异均有统计意义(P<0.05)。观察组总有效率为95.34%,明显高于对照组(65.12%),差异有统计学意义(P<0.05)。两组均无明显不良反应,或不良反应耐受。结论消炎止痛膏联合钻孔减压自体髂骨松质骨打压植骨有利于改善早期股骨头坏死患者神经系统功能及髋关节功能,值得临床予以推广应用。

Objective To analyze the effect of Xiaoyan Zhitong Ointment combined with drilling decompression of autoiliac bone cancellous bone compression bone graf in the treatment of early osteonecrosis of the femoral head.Methods Eighty-six patients with early osteonecrosis of the femoral head admitted to Tangshan Second Hospital from January 2019 to December 2020 were prospectively selected as the study subjects.According to the random number table method,they were divided into two groups,each group 43 cases.The control group was treated with drilling decompression autologous iliac cancellous bone compression and bone grafting,and the observation group was treated with Xiaoyan Zhitong Ointment combined with drilling decompression and autogenous iliac cancellous bone compression and bone grafting.The treatment effects of two groups of femoral head necrosis,Harris hip joint function score,the levels of plasma central nervous system specific protein S-100B and neuron specific enolase(NSE)before and after treatment,and incidence of adverse reactions were observed and compared,and statistical analysis was conducted.Results The Harris scores of the two groups were significantly improved at 3,6 and 12 months after treatment,and the Harris scores of the observation group after treatment were(77.23±7.65),(83.84±6.69),(86.71±6.15)points,respectively,which were significantly higher than those of the control group[(72.91±8.12),(79.31±6.25),(83.22±6.33)points],and the differences were statistically significant(P<0.05).The levels of plasma S-100B and NSE in the two groups were significantly reduced at 4,8 and 12 weeks after treatment,and the levels of plasma S-100B in the observation group after treatment were(75.21±6.66),(72.85±6.05),(70.55±5.93)ng/mL,respectively,and NSE were(15.41±3.96),(13.73±3.31),and(12.35±2.87)ng/mL,respectively,which were significantly lower than those in the control group[(78.94±7.11),(76.33±6.31),(74.44±6.22)ng/mL;NSE:(17.19±4.13),(15.86±3.97),(14.03±3.61)ng/mL],and the differences were statistically significant significance(P<0.05).The total effective rate of the observation group was 95.34%,which was significantly higher than that of the control group(65.12%),and the difference was statistically significant(P<0.05).There were no obvious adverse reactions or tolerated adverse reactions in both groups.Conclusion Xiaoyan Zhitong Ointment combined with drilling decompression and autogenous iliac cancellous bone compression and bone grafting is beneficial to improve the nervous system function and hip joint function of patients with early osteonecrosis of the femoral head,and it is worthy of clinical application.