平卧位OCM入路全髋关节置换联合加味地黄桃仁牛膝汤治疗老年股骨头坏死患者的临床效果

Clinical Observation of Total Hip Replacement Combined with Modified Dihuang Taoren Niuxi Decoction for the Treatment of Senile Femoral Head Necrosis by Supine OCM Approach

目的探讨平卧位OCM入路全髋关节置换术(THA)联合加味地黄桃仁牛膝汤在老年股骨头坏死(ONFH)患者中的应用价值。方法选取2019年10月至2022年10月南阳市中医院收治的94例老年ONFH患者,随机分为两组,各47例,对照组行平卧位OCM入路THA,观察组于此基础上加用加味地黄桃仁牛膝汤,疗程为8周。比较两组患者入院时和治疗后影像疗效、视觉模拟量表(VAS)评分、骨代谢指标[骨钙素(BGP)、骨特异性碱性磷酸酶(BAP)、抗酒石酸酸性磷酸酶-5b(TRACP-5b)]、下肢血液循环指标[阻力指数(RI)、踝肱指数(ABI)、搏动指数(PI)]及术后并发症情况。结果治疗后观察组患者的影像疗效评分为(5.32±1.02)分,低于对照组的(5.97±1.13)分,VAS评分为(3.83±1.05)分,低于对照组的(4.69±1.24)分,差异有统计学意义(P<0.05);治疗后观察组患者的BGP为(8.75±0.84)ng·L^(-1),高于对照组的(8.02±0.82)ng·L^(-1),BAP为(33.27±4.15)ng·L^(-1),高于对照组的(29.41±3.79)ng·L^(-1),TRACP-5b为(1.79±0.16)U·L^(-1),低于对照组的(2.20±0.18)U·L^(-1),差异有统计学意义(P<0.05);治疗后观察组患者的RI为0.89±0.10,低于对照组的0.98±0.12,ABI为0.87±0.08,高于对照组的0.75±0.09,PI为7.02±1.07,低于对照组的(7.84±1.15),差异有统计学意义(P<0.05);两组患者的术后并发症发生率比较,差异无统计学意义(P>0.05)。结论平卧位OCM入路全髋关节置换联合加味地黄桃仁牛膝汤治疗老年ONFH患者,能改善血液循环,促进骨质代谢,增强疗效,有较好安全性。

Objective To explore the application value of supine OCM approach total hip arthroplasty(THA)combined with modified Dihuang Taoren Niuxi Decoction in the treatment of elderly patients with osteonecrosis of the femoral head(ONFH).Methods A total of 94 elderly patients with ONFH from October 2019 to October 2022 in Nanyang Hospital of Traditional Chinese Medicine were randomly divided into two groups,with 47 cases in each group.The control group underwent THA with OCM approach in supine position,while the observation group received the modified Dihuang Taoren Niuxi Decoction on top of this,and the course of treatment for both groups was 8 weeks.The imaging efficacy,visual analog scale(VAS)scores,bone metabolic indicators[bone gla protein(BGP),bone specific alkaline phosphatase(BAP),tartrate-resistant acid phosphatase-5b(TRACP-5b)],lower limb blood circulation indicators[resistance index(RI),ankle brachial index(ABI),pulsatility index(PI)],and postoperative complications were compared between the two groups at admission and after treatment.Results After treatment,the imaging efficacy score of the observation group was(5.32±1.02)scores,which was lower than that of the control group[(5.97±1.13)scores],and the VAS score was(3.83±1.05)scores,which was lower than that of the control group[(4.69±1.24)scores],with a statistically significant difference(P<0.05).After treatment,the BGP of the observation group was(8.75±0.84)ng·L^(-1),which was higher than that of the control group[(8.02±0.82)ng·L^(-1)],and the BAP was(33.27±4.15)ng·L^(-1),which was higher than that of the control group[(29.41±3.79)ng·L^(-1)],and the TRACP-5b was(1.79±0.16)U·L^(-1),which was lower than that of the control group[(2.20±0.18)U·L^(-1)],with statistically significant differences(P<0.05).After treatment,the RI of the observation group was 0.89±0.10,which was lower than that of the control group(0.98±0.12),and the ABI was 0.87±0.08,which was higher than that of the control group(0.75±0.09),and the PI was 7.02±1.07,which was lower than that of the control group(7.84±1.15),with statistically significant differences(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion The treatment of elderly ONFH patients with OCM approach in the supine position combined with the modified Dihuang Taoren Niuxi Decoction can improve blood circulation,promote bone metabolism,enhance efficacy,and have good safety.