带股外侧肌蒂大转子骨瓣移植联合补肾活血汤治疗早中期股骨头坏死临床研究

发布时间：2018-06-23 00:10

  本文选题：大转子骨瓣 + 中药内服　； 参考：《南京中医药大学》2016年硕士论文

【摘要】：目的 通过临床回顾性研究,对比分析带股外侧肌蒂大转子骨瓣移植联合补肾活血汤治疗早中期股骨头坏死与单纯的手术治疗的临床疗效,观察保髋临床疗效,从而为中医药治疗股骨头坏死提供临床依据,提高保髋手术的成功率。方法选择2010年02月～2014年02月本院收治的早中期股骨头坏死54例(60髋),分成治疗组、对照组两组,其中治疗组：采用带股外侧肌蒂大转子骨瓣移植联合补肾活血汤治疗32髋；对照组：采用带股外侧肌蒂大转子骨瓣移植治疗28髋；观察2组患者的临床疗效并进行比较,采用中华医学会骨科分会百分比评价法对所有结果统计分析,进行疗效评估,比较治疗前与治疗12个月的疼痛,功能,关节活动度及X线评分,并且比较两组患者末次随访的百分比优良率,从而分析其他因素对临床疗效的影响。结果根据治疗一年的随访统计结果,两组患者的髋关节疼痛均明显减轻或消失,髋关节活动度及功能得到改善,治疗前与治疗一年时疼痛、功能、X线评分、总分数比较其差异性均有统计学意义(P0.05)。在治疗一年的随访结果统计表中,治疗组在疼痛评分、功能评分、X线评分以及总分显著高于对照组,差异具有统计学意义(P0.05)；在治疗一年时治疗组优良率81.2%,对照组优良率71.4%,中药治疗组的优良率明显高于对照组；在治疗一年时所有患者在不同年龄阶段的优良率分别为87.88%、70.37%,表明在中早期股骨头坏死的年轻患者效果更好；在治疗一年时两组患者在JIC分型A-B型的优良率分别为90.9%、80%,在C1-C2型的优良率分别为60%、50%,表明：外侧柱越完整,股骨头坏死的保髋临床疗效就越好。在治疗一年时两组患者在ARCOⅡA-ⅡC期的优良率分别为95.45%、84.21%,在ARCOⅢA-ⅢB期的优良率分别为50%、44.44%,说明股骨头坏死的分期越早,效果越好,随着分期的进展临床效果越来越差。结论带股外侧肌蒂大转子骨瓣移植联合补肾活血汤治疗早中期股骨头坏死临床疗效显著,能够提高早中期股骨头坏死患者的保髋成功率,改善股骨头坏死预后。
[Abstract]:Objective to compare and analyze the clinical effect of the transplantation of great trochanter bone flap with lateral femoral muscle pedicle and Bushen Huoxue decoction in treating necrosis of femoral head and simple operation in early and middle period through clinical retrospective study, and to observe the clinical effect of hip preservation. So as to provide the clinical basis for the treatment of femoral head necrosis and improve the success rate of hip-preserving surgery. Methods from February 2010 to February 2014, 54 cases (60 hips) with necrosis of femoral head were divided into treatment group and control group. 32 hips were treated with pedicled great trochanteric bone flap transplantation with lateral femoral muscle pedicle combined with Bushen Huoxue decoction. Control group: 28 hips were treated with pedicled greater trochanter bone flap with lateral femoral muscle pedicle, the clinical efficacy of the two groups was observed and compared, and all the results were statistically analyzed and evaluated by the percentage evaluation method of the Chinese Medical Association Orthopedic Branch. Pain, function, joint motion and X-ray score were compared before and after 12 months of treatment, and the percentage of excellent and good rates of the last follow-up were compared between the two groups, so as to analyze the effect of other factors on the clinical efficacy. Results according to the results of follow-up for one year, the pain of hip joint in both groups was obviously alleviated or disappeared, the motion and function of hip joint were improved, the pain and the score of functional X-ray were obtained before and after treatment for one year. The difference of total score was statistically significant (P0.05). In the statistical table of follow-up results for one year, the scores of pain, function, X-ray and total score in the treatment group were significantly higher than those in the control group (P0.05). The excellent and good rate was 81.2% in the treatment group and 71.4% in the control group. The excellent and good rate of the traditional Chinese medicine treatment group was significantly higher than that of the control group. The excellent and good rates of all patients at different ages were 87.88 and 70.37 respectively at one year, which indicated that the young patients with femoral head necrosis in the middle and early stage had better results. At one year after treatment, the excellent and good rates of the two groups in JIC typing A-B were 90.9 and 80, respectively, and the excellent and good rates in C1-C2 were 60 and 50, respectively. The results showed that the more complete the lateral column, the better the clinical efficacy of hip preservation in osteonecrosis of femoral head. The excellent and good rates of ARCO 鈪，

本文编号：2054833