针刀疗法改善股骨头坏死患者关节功能的疗效及相关因素分析

发布时间：2018-06-27 09:07

本文选题：针刀疗法 + 股骨头坏死　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:通过比较不同影响因素对针刀治疗股骨头坏死的疗效差异,分析影响针刀疗法改善股骨头坏死患者关节功能的相关因素,为针刀治疗股骨头坏死提供理论依据和应用参考,优化股骨头坏死的临床治疗方案,进一步提高治疗的疗效。方法:选取来自于2014年2月至2015年6月在望京医院骨关节三科住院接受针刀治疗的股骨头坏死病例,按照纳入、排除标准最后纳入研究的病例共50例,共75髋,脱落4例,5髋。设计统一标准的股骨头坏死病例报告表。所有入组患者根据患者功能受限的程度及临床症状,选择性采用不同的针刀松解方法。主要有髋关节囊针刀松解、髋内侧针刀松解、髋外侧松解。在治疗后1周,2周,3个月,6个月后进行临床随访,每次随访均详细填写CRF表。CRF表录入采用双人双录,专人核对的方式。最后所得数据采用SPSS20.0统计学软件包处理,设定P0.05具有有统计意义。分析针刀疗法改善股骨头坏死患者关节功能的疗效并比较在职业、病因、病程、影像分期等相关因素的疗效差异。结果:本研究随访资料满半年的患者46例70髋。其中男性27例40髋,女性19例30髋。体力劳动9例占19.57%,非体力劳动20例占43.48%,无职业17例占36.95%;特发性股骨头坏死17例占36.96%,创伤性股骨头坏死2例占4.34%,激素性股骨头坏死15例占32.61%,酒精性股骨头坏死12例占26.09%;病程半年以内15例占32.61%,半年到一年13例占28.26%,1年以上18例占19.13%;按ARCO股骨头坏死分期标准进行分期:其中Ⅱ期:20髋;Ⅲ期:33髋;Ⅳ期:17髋。总体结果显示:针刀治疗前后VAS评分:治疗前4.65±1.303,治疗后1周3.79±1.167(P0.05),.治疗后6个月2.48±1.188(P0.05);Harris评分:治疗前68.34±14.22,治疗后3个月 83.04±12.79(P0.05),治疗后 6 个月 85.18±10.49(P0.05);关节活动度:治疗前184.36±49.63,治疗后1周227.14±35.16(P0.05),治疗后6个月242.13±33.61(P0.05)。不同影像分期关节活动度多重比较:1周随访时,Ⅳ期与Ⅱ期对比患者关节活动度改善了 44.206±10.941(P0.05),Ⅳ期与Ⅲ期对比患者关节活动度改善了30.312±9.902(P0.05);6个月随访时,Ⅳ期与Ⅱ期对比患者关节活动度改善了 59.941±10.738(P0.05),Ⅳ期与Ⅲ期对比患者关节活动度改善了 38.275±9.718(P0.05);结果示Ⅳ期比Ⅱ期、Ⅲ期的患者关节活动度改善更加明显,差异有统计学意义(P0.05)。VAS评分多重比较:在随访1周时,Ⅱ期比Ⅲ期、Ⅳ期的患者疼痛程度改善更大;而在6个月随访时Ⅳ期比Ⅱ期、Ⅲ期的患者疼痛改善程度大,差异无统计学意义(P0.05)。不同病因关节活动度多重比较,激素性较特发性及酒精性的患者关节活动度改善程度大,差异无统计学意义(P0.05)。VAS评分多重比较,激素性较特发性及酒精性的患者疼痛改善程度大,差异无统计学意义(P0.05)。不同病程关节活动度多重比较,病程1年的患者关节活动度改善更大,差异无统计学意义(P0.05)。VAS评分多重比较,在1周随访时病程在6月-1年的患者疼痛程度改善情况比病程6月及1年的更好,而在随访6个月时病程1年的患者疼痛程度改善情况比病程6月-1年及6月的更好,差异无统计学意义(P0.05)。不同职业类型关节活动度多重比较,无职业的患者关节活动度改善程度大,差异无统计学意义(P0.05)。VAS评分多重比较,无职业的患者疼痛改善程度大,差异无统计学意义(P0.05)。结论:1.对于股骨头坏死患者,针刀治疗对缓解髋关节疼痛症状、改善关节活动度具有良好的疗效,尤其是在关节活动功能改善方面更具有特色。2.术前的影像分期是影响针刀治疗股骨头坏死患者关节功能疗效的重要的因素。3.采用针刀治疗不论何种病因、病程长短、何种职业的股骨头坏死患者,均能有效的改善其疼痛及关节活动度。
[Abstract]:Objective: To compare the effects of different influence factors on the treatment of femoral head necrosis with Acupotomy, analyze the related factors that affect the joint function of the patients with femoral head necrosis, provide the theoretical basis and application reference for the Acupotomy for the necrosis of the femoral head, optimize the clinical treatment plan of the femoral head necrosis, and further improve the therapeutic effect. Methods: a total of 50 cases of avascular necrosis of the femoral head were selected from February 2014 to June 2015 in the three families of bone and joint in Wangjing Hospital. A total of 75 hips, 4 cases and 5 hips were selected according to the inclusion and exclusion criteria. The degree and clinical symptoms were limited and the different needle knife loosening methods were selected. The main results were the loosening of the hip sacs, the loosening of the hip medial acupotomy, and the lateral release of the hip. 1 weeks, 2 weeks, 3 months, and 6 months after the treatment were followed up, and the CRF table.CRF was recorded in a double record, and the best way to check. The following data were processed by SPSS20.0 statistics software package, and P0.05 had statistical significance. The curative effect of needle knife therapy on the improvement of joint function in patients with femoral head necrosis was analyzed and the difference in the effect of related factors in occupation, etiology, course of disease, and image staging were compared. Results: 46 cases of 70 hips in this study were followed up for half a year. Among them, male 2 There were 40 hips in 7 cases, 19 cases of 30 hips in women, 19.57% in manual labor, 43.48% for non manual labor, 43.48% for non manual labor, 36.95% in no occupation, 17 in the femoral head necrosis of idiopathic femoral head 36.96%, traumatic femoral head necrosis in 2 cases, steroid femoral head necrosis and alcoholic femoral head necrosis within half a year. A year to one year 13 cases accounted for 28.26%, and more than 1 years 18 cases accounted for 19.13%. According to the ARCO staging of avascular necrosis of the femoral head, stage II: 20 hips, stage III, 33 hips, and 17 hips. Overall results showed that before and after acupotomy, the VAS score was 4.65 + 1.303, 1 weeks 3.79 + 1.167 (P0.05) after treatment. After treatment, Harris score: treatment: treatment: treatment The first 68.34 + 14.22, 3 months 83.04 + 12.79 (P0.05) after treatment, 6 months after treatment 85.18 + 10.49 (P0.05), joint activity: 184.36 + 49.63 before treatment, 227.14 + 35.16 (P0.05) after treatment, P0.05 after treatment. The mobility improved by 44.206 + 10.941 (P0.05). The joint activity of patients in stage IV and stage III was improved by 30.312 + 9.902 (P0.05). During the 6 month follow-up, the joint activity in stage IV and stage II was improved by 59.941 + 10.738 (P0.05), and the joint activity in stage IV and stage III was improved by 38.275 + 9.718 (P0.05), and the results showed stage IV than phase II, The improvement of joint activity in stage III patients was more obvious, and the difference was statistically significant (P0.05).VAS score: at 1 weeks of follow-up, the pain degree of patients in stage II was better than in stage III and stage IV, while in the 6 months follow-up period, the degree of pain in stage IV was larger than that in stage II, and there was no significant difference (P0.05). There was no statistically significant difference (P0.05).VAS score, and there was no significant difference in pain improvement between steroid and alcoholic patients (P0.05). There was no significant difference in the degree of joint activity in different course of disease (P0.05). The course of disease was 1 years. The patient's joint activity was improved more, with no statistically significant difference (P0.05).VAS score. At 1 weeks of follow-up, the improvement of pain was better than that in June and 1 years in the 1 week of June, and the degree of pain in patients with a 6 month follow-up of 1 years was better than that in the course of the course of the disease in June -1 and June. Statistical significance (P0.05). The joint activity of different occupational types was compared. There was no significant difference in the degree of improvement of joint activity in the non occupational patients (P0.05), and there was no significant difference (P0.05).VAS score. The pain improvement degree of the non occupational patients was large and the difference was not statistically significant (P0.05). Conclusion 1. for patients with femoral head necrosis, Acupotomy treatment is slow The symptoms of hip joint pain and the improvement of joint activity have good curative effect. Especially in the improvement of joint function, the image staging of.2. before operation is an important factor affecting the curative effect of the joint function of the patients with femoral head necrosis..3. using needle knife to treat the cause of the disease, the length of the disease, and what kind of occupation Patients with osteonecrosis can effectively improve their pain and joint mobility.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.9

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