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    院内制剂扶骨养血片治疗股骨头坏死的临床分析

    出处:论文网
    时间:2019-09-11

    院内制剂扶骨养血片治疗股骨头坏死的临床分析

      【中图分类号】R917 【文献标识码】A 【文章编号】1005-0019(2019)15--02

      股骨头坏死(ONFH)是临床上常见的骨科难治疾病之一,多因风湿病,潜水病,外伤等疾患引起,激素服用史和酗酒史也可造成股骨头坏死,其主要发病机制是临近关节血供不足,继而造成股骨头骨细胞血供不足、坏死,骨细胞进一步缺血坏死,骨小梁断裂、股骨头塌陷,造成残疾[1-2]。治疗股骨头坏死中医讲究阴阳调和,内因外因相互制约。采用活血化瘀,补气养血的药物,使得气血平衡疗效为佳。而该次研究主要是对2017年12月—2018年6月该院诊治的20例股骨头坏死患者采用中药治疗股骨头坏死的疗效,现报道如下。

      1 资料与方法

      1.1 临床资料 该次研究是调取该院2017年12月—2018年6月该院诊治的20例股骨头坏死的临床资料,其中男12例,女8例。年龄19~66岁,平均(44±3.5)岁。病程2~15年,平均(5±1.3)年;20例患者的自然条件无统计学意义。其中激素史服用的有8例,外伤史的有6例,酗酒史有7例,无明显病因的有3例。临床体征为:双侧股骨头坏死12例,单侧股骨头坏死8例,主要症状为髋关节区疼痛15例,跛行3例,单侧无法行走4例,双侧无法行走2例,无症状者7例。

      1.2 方法

      A组采用Seldinger法,于对侧股动脉穿刺,插入导管鞘,根据造影进行选择性旋股内动脉、旋骨外动脉及闭孔动脉插管,并经导管导入中药复方丹参注射液30 mL,黄芪注射液30 mL。介入治疗后,嘱患者24 h卧床休息。

      B组采用院内制剂扶骨养血片(0.4 g /片,100片/盒,批准文号 黑制Z20170003)内服治疗。其主要成分为:鹿茸、骨碎补、血竭、土鳖虫、何首乌、龟板、乳香(制)、没药(制)等14味制成。饭后30分钟口服。一次6-10片,一日2次。1个疗程3个月;6个月后观察疗效。

      1.3 疗效评定标准

      痊愈:无跛行,疼痛,下肢形态基本正常,生理功能基本恢复;X线显示塌陷骨,死骨基本消失,有新骨行成。好转:症状减轻,疼痛缓解,下肢生理形态和功能有改善或下肢有缩短1 cm左右; X线显示骨坏死区及骨塌陷区有改善。无效:症状无改善;X线无明显改善。

      1.4 统计方法 对文中所得数据进行统计学处理,采用SPSS15.0软件进行分析,计量资料采用t检验,计数资料采用χ2检验。

      2 结果

      2.1 A、B组患者治疗后转归情况

      经介入治疗及中药治疗后,患者的临床症状(髋关节区疼痛、跛行、单侧无法行走、双侧无法行走)均有有明显改善,但二者之间统计学差异不大。

      2.2 两组患者经中药内服外用治疗及介入之治疗后的病情转归

      采用院内制剂扶骨养血片治疗股骨头坏死的有效率为90%,大于介入治疗股骨头坏死的有效率70%,差异有统计学意义(P<0.05)。另外经过6个月后DSA复查显示股骨头血管普遍增多,患者的旋股内动脉变粗,分支增多,闭孔动脉及旋股外动脉的分支均有明显增多,提示治疗有效。X线也显示出大量的坏死骨、塌陷骨消失,新骨形成。

      3 讨论

      股骨头坏死(ONFH)是世界上公认的骨科疑难顽症之一。它的发病常见的原因主要有酒精刺激、激素摄入、外伤等。近年来,由于激素药物的广泛应用,股骨头坏死的发病率也日趋增高。股骨头坏死多见于中年男性,以双侧股骨头坏死多见,大多一侧病情较重,一侧较轻。股骨头坏死发病机制主要是股骨头供给血管阻塞,导致股骨头中骨细胞血供不足,给养减少发生坏死现象。所以股骨头坏死发病的主要原因就是血供受阻。它的主要临床表现是髋关节阵发性疼痛、酸痛,站立或行走时加重为首要症状,随着病情发展,疼痛发展为持续性疼痛,髋关节活动受限,肌肉萎缩,伴有下肢疼痛或畏寒(怕冷),严重的可以导致下肢缩短,跛行,甚至残疾。影响日常生活及工作。当今临床上主要治疗手段是非手术治疗的综合疗法。

      股骨头坏死在中医学上被认为是气血不通、瘀滞,产生淤血,气血是骨骼维持正常形态和功能的关键,经络受阻,气血不畅,骨骼滋养受阻,必然导致骨质坏死[3]。故又称“骨蚀”。因此,中医学认为活血化瘀是治疗的关键。院内制剂扶骨养血片主要功效是补肝益肾、活血化瘀、通络止痛。中药治疗采用内服活血化瘀、补肾强骨的药物—补肾活骨汤水。方中土鳖虫、血竭等具有调节血液流变特性、降血脂、改善微循环、扩张外周血管、镇痛局部抗炎等作用。可以防治早期股骨头坏死[4]。另外,活血化瘀药可以改变骨髓腔内淤血状态,促进骨头内微循环形成,增加血流灌注量。从而降低骨内高压,减轻局部症状。另外有研究表明,此药可以促进股骨头局部转化生长因子(TGF-β1)表达,促进坏死骨质自我修复。此外,鹿茸、何首乌可以解郁,使气血畅通,提高免疫力同时缓解疼痛,稳定心神。该次研究采用院内制剂扶骨养血片进行治疗,使得患者病情好转,临床症状减轻,可以证实中药治疗股骨头坏死在临床上治疗效果明显。

    院内制剂扶骨养血片治疗股骨头坏死的临床分析

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