骨髓水肿与股骨头坏死中医综合保髋影像学变化的相关研究

发布时间：2018-01-18 07:34

本文关键词：骨髓水肿与股骨头坏死中医综合保髋影像学变化的相关研究　出处：《广州中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：股骨头坏死是骨科领域常见且难治的疾病,具有致残率高、疗效不佳、严重影响患者生活质量的特点。现有治疗方法主要有保髋治疗和人工关节置换。因股骨头坏死好发于中青年,若过早行人工关节置换,患者可能面临多次翻修手术。因此,股骨头坏死早中期应首选保髋治疗。MRI显示的骨髓水肿是股骨头坏死病情发展过程中的伴随现象,其发生机制尚不明确,且与股骨头坏死保髋疗效的相关研究偏少。本研究的目的是分析不同程度骨髓水肿对股骨头坏死中医综合保髋治疗后的影像学变化的影响,探究骨髓水肿的发生机制和寻找骨髓水肿出现时合适的保髋治疗方法。方法：采用回顾性分析法,病例全部来源于2010年9月至2013年10月在广州中医药大学第一附属医院行中医综合保髋治疗的股骨头坏死的患者。按MRI显示的骨髓水肿程度分为2大组,最终纳入观察病例53例73髋,其中轻度骨髓水肿41髋,重度骨髓水肿32髋。平均随访28.07±6.33个月(19-43个月)。分别对比两组在年龄、性别、中医证型、手术方式、股骨头生存时间、末次随访的正位及蛙位股骨头塌陷程度、术后股骨头X线进展(头臼关系、关节稳定)之间的差异。研究结果使用SPSS19.0进行统计学处理,以P0.05为差异有统计学意义。结果：不同证型组间的骨髓水肿程度差异有统计学意义,其中肾虚血瘀证组与痰瘀蕴结证组间的骨髓水肿程度差异有统计学意义(P0.05),肾虚血瘀证组以轻度骨髓水肿为主27髋(73.0%),痰瘀蕴结证组以重度骨髓水肿为主18髋(72.0%)。不同骨髓水肿程度的股骨头,术后正位及蛙位进一步塌陷的程度差异均有统计学意义(P0.05),轻度骨髓水肿组术后正位及蛙位进一步塌陷程度较轻。微创手术组中,术后末次随访时,不同骨髓水肿程度的股骨头正位及蛙位进一步塌陷的程度差异均有统计学意义(P0.05),轻度骨髓水肿组术后正位及蛙位进一步塌陷程度较轻。轻度骨髓水肿组中,术后末次随访X线上,微创手术组与切开手术组比较,股骨头的正位及蛙位进一步塌陷程度、头臼匹配关系、关节稳定程度差异均有统计学意义(P0.05),微创手术组的术后正位及蛙位进一步塌陷程度均显著低于切开手术组,头臼匹配关系、关节稳定程度较切开手术组好。重度骨髓水肿组中,术后末次随访X线上,微创手术组与切开手术组比较,股骨头蛙位进一步塌陷及关节稳定情况方面差异有统计学意义(P0.05),微创手术组的术后蛙位进一步塌陷程度显著低于切开手术组,关节稳定程度较切开手术组好。骨髓水肿程度与年龄之间差异无统计学意义(P0.05),但重度骨髓水肿的年龄较轻度骨髓水肿的大。不同性别的骨髓水肿程度之间差异无统计学意义(P0.05)。轻度和重度骨髓水肿的股骨头生存率曲线之间差异无统计学意义(P0.05)。切开手术组中,术后末次随访X线上,不同骨髓水肿程度的术后4项影像学观察指标差异均无统计学意义(P0.05)。结论：1、骨髓水肿是由股骨头坏死修复中的机械应力异常引起,其出现可能与股骨头内不稳定,骨小梁应力性骨折有关。2、骨髓水肿可影响股骨头坏死保髋治疗结局,严重骨髓水肿的治疗结局比轻度骨髓水肿的差。3、当出现严重骨髓水肿时,应及时干预,减轻骨髓水肿,防止疾病进一步恶化。
[Abstract]:Objective: the femoral head is a common Department of orthopedics and refractory disease, with high rate of disability, poor efficacy, seriously affect the characteristics of the quality of life of the patients. The existing treatment methods are mainly hip preserving treatment and artificial joint replacement for femoral head necrosis occurs in the youth, if too early artificial joint replacement, patients may face many times of revision surgery. Therefore, femoral head necrosis at early stage should be the first choice of hip preserving.MRI showed bone marrow edema is accompanied by the phenomenon of avascular necrosis of the femoral head during the progression of disease, its pathogenesis is still unclear, and the related research of ONFH curative effect is less. The purpose of this study is to analyze the impact of different degrees the changes of bone marrow edema in the treatment of osteonecrosis of integrated traditional Chinese Medicine Hip preserving stocks of the image, and find the mechanism of bone marrow edema appeared right hip preserving treatment of bone marrow edema. Methods: Using A retrospective analysis of femoral head necrosis were all treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine for integrated traditional Chinese medicine from September 2010 to October 2013 of the hip preserving patients. According to the degree of bone marrow edema MRI display, divided into 2 groups, included 53 cases were observed in 73 hips, 41 hips in the mild bone marrow edema, severe bone marrow edema in 32 hip. Average follow-up was 28.07 + 6.33 months (19-43 months) respectively. Comparing the two groups in age, gender, type of Chinese medicine, surgery, the femoral head survival time of the last follow-up anteroposterior and frog position degree of collapse of femoral head after operation of femoral head, progress of X-ray (femoral head, joint stability) the difference between the use of SPSS19.0. The results were analyzed statistically by P0.05, the difference was statistically significant. Results: there was significant difference in bone marrow edema in different syndrome groups, including kidney deficiency and blood stasis syndrome group and the phlegm and blood stasis stagnation syndrome group There was significant difference between the degree of bone marrow edema (P0.05), kidney deficiency and blood stasis in patients with mild bone marrow edema in 27 hips (73%), phlegm and blood stasis group with severe bone marrow edema in 18 hips (72%). The different degree of bone marrow edema of the femoral head, postoperative anteroposterior and frog position difference step the collapse had statistical significance (P0.05), mild bone marrow edema group postoperative anteroposterior and frog position further collapse to a lesser extent. Minimally invasive surgery group, the last follow-up after operation, the different degree of bone marrow edema of the femoral head in the anteroposterior and frog position differences in the degree of further collapse had statistical significance (P0.05), mild bone marrow edema group after operation anteroposterior and frog position further collapse to a lesser extent. Mild bone marrow edema group, postoperative follow-up X-ray, minimally invasive surgery group and open surgery group, the femoral head is a bit further and the frog collapse degree of femoral head, joint instability The degree of the differences were statistically significant (P0.05), minimally invasive surgery group postoperative anteroposterior and frog position further collapse degree were significantly lower than those in open surgery group, femoral head, joint stability is better than open surgery group. Severe bone marrow edema group, postoperative follow-up X-ray, minimally invasive and open surgery group the operation group, there was statistical significance of femoral head collapse and joint frog bit further stability difference (P0.05), minimally invasive surgery group after surgery was significantly lower than that in frog position further collapse incision group, the degree of stability is cut open joint surgery group. There was no significant difference between the degree of bone marrow edema with age (P0.05). But the age of severe bone marrow edema and mild bone marrow edema. There was no significant difference between the degree of bone marrow edema of different gender (P0.05). Mild and severe bone marrow edema of the femoral head survival rate curve There was no statistically significant difference (P0.05). Open surgery group, postoperative follow-up X-ray, different degree of bone marrow edema after surgery 4 imaging observation index showed no significant difference (P0.05). Conclusion: 1, bone marrow edema is caused by abnormal repair of femoral head necrosis in mechanical stress. It may appear in the femoral head and unstable bone related.2 small beam stress fracture, bone marrow edema can affect the treatment outcome of ONFH, severe bone marrow edema treatment outcome than mild bone marrow edema in.3, when a serious bone marrow edema, timely intervention, reduce bone marrow edema, to prevent further deterioration of the disease.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R274.9;R445.2

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