基于络病理论探讨股骨头坏死患者的疼痛特点及疼痛区域经脉循行特点

Investigation on the characteristics of pain and running courses of meridians in the pain areas of patients with osteonecrosis of the femoral head based on the collateral disease theory

目的:探讨股骨头坏死(osteonecrosis of the femoral head,ONFH)患者的疼痛特点及疼痛区域经脉循行特点。方法:选择2020年5月至2021年7月在广州中医药大学第三附属医院门诊或住院治疗的ONFH患者为研究对象。国际骨循环学会(Association Research Circulation Osseous,ARCO)分期均为Ⅰ期、Ⅱ期,男209例、女74例,年龄(42.87±14.52)岁,左侧97例、右侧81例、双侧105例,酒精性ONFH101例、激素性ONFH85例、特发性ONFH59例、创伤性ONFH38例。收集患者信息,进行ONFH临床病例信息登记。统计登记的信息,包括患者性别、年龄、病变侧别、中医证型及疼痛情况(包括性质、程度、区域、昼夜变化、是否固定、诱发因素、休息是否缓解)等;比对患者疼痛区域足三阴经和足三阳经的循行情况,统计各条经脉出现的频次;按年龄和中医证型分组,分析不同年龄和不同中医证型患者疼痛区域经脉循行的特点。结果:①疼痛情况。283例ONFH患者,疼痛性质以隐痛较常见,疼痛程度以轻中度为主且昼夜变化不明显,疼痛区域以腹股沟和股外侧最多见且位置多固定,诱发疼痛的因素有多种,大部分患者休息后疼痛能缓解。②疼痛区域经脉循行情况。283例(388髋)ONFH患者,疼痛区域有单一经脉循行186髋,有2条或2条以上经脉循行202髋;疼痛区域循行经脉出现频次较高的为足厥阴肝经和足少阳胆经。③不同年龄和不同中医证型患者疼痛区域经脉循行情况。283例ONFH患者,年龄<50岁186例,年龄≥50岁97例;气滞血瘀证56例,肾虚血瘀证142例,痰瘀互结证85例。疼痛区域循行经脉按出现频次由高至低排序,年龄<50岁组为足厥阴肝经、足少阳胆经、足太阳膀胱经、足太阴脾经、足少阴肾经、足阳明胃经,年龄≥50岁组为足少阳胆经、足厥阴肝经、足太阳膀胱经、足阳明胃经、足太阴脾经、足少阴肾经,气滞血瘀证组为足厥阴肝经、足少阳胆经、足太阳膀胱经、足阳明胃经、足太阴脾经、足少阴肾经;肾虚血瘀证组、痰瘀互结证组均为足厥阴肝经、足少阳胆经、足太阳膀胱经、足太阴脾经、足阳明胃经、足少阴肾经。结论:ARCO分期Ⅰ期、Ⅱ期ONFH患者的疼痛多为位置固定的轻中度隐痛,疼痛程度昼夜变化不明显,大部分患者休息后疼痛能缓解,疼痛区域以腹股沟和股外侧最多见;疼痛区域有足三阴经和足三阳经循行,循行经脉中足厥阴肝经和足少阳胆经最多见。

Objective:To explore the characteristics of pain and running courses of meridians in the pain area of patients with osteonecrosis of the femoral head(ONFH).Methods:Two hundred and eighty-three ONFH patients treated in the outpatient or inpatient department of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2020 to July 2021 were selected as the subjects.The patients included 209 males and 74 females,with the age of 42.87±14.52 years.The ONFH located in left side for 97 patients,right for 81 ones and bilateral for 105 ones,and belonged to stageⅠand stageⅡaccording to the staging standard issued by the Association Research Circulation Osseous(ARCO),besides,the ONFH covered alcohol-induced ONFH(101 cases),steroid-induced ONFH(85 cases),idiopathic ONFH(59 cases)and traumatic ONFH(38 cases).The patient information,including gender,age,affected side,traditional Chinese medicine(TCM)syndrome type and pain characteristics(nature,degree,area,day-night variation,fixed position or not,inducing factors,and relief upon rest or not,etc.),was collected and recorded.The running courses of the three Yin meridians and three Yang meridians of the foot in the pain areas was compared,followed by statistics on the occurrence frequency of each meridian.The patients were grouped according to their ages and TCM syndrome types,and the characteristics of running courses of each meridian in the pain areas of patients with different TCM syndrome types in different ages were analyzed.Results:①The 283 ONFH patients mainly presented mild-to-moderate dull pain with the unobvious day-night variation.The pain mainly occurred in the groin and lateral femur mostly with the fixed position,and it could be triggered by multiple factors.Most patients experienced pain relief upon rest.②Among the 283 ONFH patients(388 hips),a single meridian was found in 186 hips,and 2 or more meridians were found in 202 hips in the pain area,among which the liver meridian of Foot-Jueyin and gallbladder meridian of Foot-Shaoyang appeared most frequently.③The 283 ONFH patients included 186 patients aged less than 50 years and 97 ones aged over 50 years.The qi-stagnation and blood-stasis syndrome was found in 56 patients,kidney-deficiency and blood-stagnation syndrome in 142 ones as well as intermingled phlegm and blood stasis syndrome in 85 ones.The meridians in the pain areas were separately ranked in a descending order by the occurrence frequency as follows:the liver meridian of Foot-Jueyin,followed by gallbladder meridian of Foot-Shaoyang,bladder meridian of Foot-Taiyang,spleen meridian of Foot-Taiyin,kidney meridian of Foot-Shaoyin and stomach meridian of Foot-Yangming in patients aged less than 50 years;while,the gallbladder meridian of Foot-Shaoyang,followed by liver meridian of Foot-Jueyin,bladder meridian of Foot-Taiyang,stomach meridian of Foot-Yangming,spleen meridian of Foot-Taiyin and kidney meridian of Foot-Shaoyin in patients aged over 50 years.Furthermore,the most frequently appeared meridian was the liver meridian of Foot-Jueyin,followed by gallbladder meridian of Foot-Shaoyang,bladder meridian of Foot-Taiyang,stomach meridian of Foot-Yangming,spleen meridian of Foot-Taiyin and kidney meridian of Foot-Shaoyin in patients with the qi-stagnation and blood-stasis syndrome;while,the liver meridian of Foot-Jueyin appeared most frequently,followed by gallbladder meridian of Foot-Shaoyang,bladder meridian of Foot-Taiyang,spleen meridian of Foot-Taiyin,stomach meridian of Foot-Yangming and kidney meridian of Foot-Shaoyin in patients with the kidney-deficiency and blood-stagnation syndrome as well as intermingled phlegm and blood stasis syndrome.Conclusion:The patients with ONFH in ARCO stageⅠandⅡmainly presented mild-to-moderate dull pain with the fixed position and the unobvious day-night variation.The pain mainly occurred in the groin and lateral femur and can be relieved after having a rest.The pain area involved three Yin meridians and three Yang meridians of the foot,among which the liver meridian of Foot-Jueyin and gallbladder meridian of Foot-Shaoyang are more common.