健脾活骨方治疗早中期非创伤性股骨头坏死临床回顾性研究

目的观察中药健脾活骨方治疗早中期非创伤性股骨头坏死（nontraumatic osteonecrosis of the femoral head，NONFH）痰瘀阻络证临床结果及疗效特点。方法采用回顾性配对对照研究方法，收集获得2年随访的早中期NONFH痰瘀阻络证患者，将经健脾活骨方治疗者设为试验组（47例），经髓芯减压病灶清除植骨手术治疗者设为对照组（48例）。收集患者治疗前后X线和临床资料，将影像稳定率和Harris评分优良率作为疗效评价指标。结果（1）试验组与对照组Harris评分优良率比较，差异无统计学意义（95.74% vs 79.17%， P>0.05），但试验组在缓解疼痛，改善关节畸形、关节活动及Harris总分方面明显优于对照组（P<0.05， P<0.01）；两组影像稳定率比较，差异无统计学意义（74.47% vs 75.00%， P>0.05）。（2）试验组与对照组国际骨循环研究学会（Association Research Circulation Osseous，ARCO）股骨头坏死分期Ⅱ期、Ⅲ期患者治疗后影像稳定率比较，差异均无统计学意义（82.05% vs 80.00%，37.50% vs 50.00%， P>0.05）。（3）试验组ARCOⅡ期患者治疗后影像稳定率及Harris评分优良率均明显高于本组Ⅲ期患者（82.05% vs 37.50%，97.44% vs 87.50%， P<0.01）。结论健脾活骨方治疗早中期NONFH影像稳定率与手术治疗结果相当，但在缓解疼痛程度、改善关节畸形和关节活动方面优于手术治疗。

英文摘要:

Objective To observe the efficacy and features of treating early to middle stage non traumatic osteonecrosis of femoral head （NONFH） patients by Jianpi Huogu Recipe （JHR）. Methods Using retrospective paired control method， early to middle stage NONFH patients treated by JHR and followed up for 2 years were recruited as the test group （47 cases）. Those accepted surgery of core decompression， focus debridement and bone graft were recruited as the control group （48 cases）. Radiographic images and clinical data of patients were collected before and after treatment. The stable rate and excellent rate of Harris score were taken as efficacy evaluation indicators. Results （1） There was no statistical difference in excellent rate of Harris score between the two groups （95.74% vs 79.17%， P>0.05）. But better effects were obtained in the test group in relieving pain， improving joint deformation， joint mobility， and total Harris score （P<0.05， P<0.01）. There was no statistical difference in the stable rate of radiography between the two groups （74.47% vs 75.00%， P>0.05）. （2） There was no statistical difference in the stable rate of radiography at phase Ⅱ and Ⅲ ［staging by Association Research Circulation Osseous （ARCO）］ between the two groups （82.05% vs 80.00%，37.50% vs 50.00%， P>0.05）. （3） The stable rate of radiography and excellent rate of Harris score were obviously higher in ARCO phase Ⅱ patients than in ARCO phase Ⅲ patients （82.05% vs 37.50%，97.44% vs 87.50%， P<0.01）. Conclusions Equivalent stable rate of radiography to that of surgery could be obtained in treating early to middle stage NONFH patients by JHR. But it was better than surgery in relieving pain， improving joint deformation and joint mobility.

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