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1、早中期非创伤性股骨头坏死中医药保髋疗效影响因素分析*何海军1刘波2 林坤弟1刘道兵1 陈卫衡1（1. 中国中医学院望京医院，北京，100102 ；2. 贵阳中医学院，贵阳，550002）【摘要】 目的：总结并分析影响早中期非创伤性股骨头坏死中医药保髋治疗的疗效影响相关因素，为提高临床效果提供理论依据。 方法：选取经中国中医科学院望京医院骨关节三科住院接受中医药保髋治疗，随访时间超过一年的早中期（ARCO II-IIIa期）非创伤性股骨头坏死，影像学检查结果为加重的患者30例，设为加重组；随机选取同期在我科住院接受相同治疗方法，影像学检查结果稳定的早中期非创伤性ONFH患者30例，设为稳定组。通
2、过Excel表格，采用双人双录，专人核对的方式，收集两组患者的临床病历资料，分析并比较两组患者在年龄、性别、职业、体重指数、病程、饮酒史、激素使用史、拄拐因素方面的差异性。 结果：加重组与稳定组在年龄、体重指数、性别比率及末次随访Harris评分比较上，差异均无统计学意义（P0.05）；加重组病程为4.10（2.09）年，高于稳定组的2.66（1.39）年，差异有统计学意义（P0.05）；加重组体力劳动者为70%，与稳定组的43.3%相比，差异有统计学意义（P0.05）；加重组酒精致病因素为43.3%，明显低于稳定组的70%（P0.05）；加重组激素致病因素为56.7%，明显高于稳定组的30%
3、（P0.05）； 结论：职业、病程、饮酒史、激素使用史、拄拐因素对早中期非创伤性股骨头坏死保髋治疗疗效影响明显，治疗中需加以重视。【关键词】非创伤性；股骨头坏死；中医药保髋；疗效影响因素Analysis of influencing factors of the efficacy of TCM hip-preserving in early-to-middle stage non-traumatic osteonecrosis of the femoral headLIU bo1 LIN kun di2 HE hai jun2 SHEN dan qing1 WANG zhen tao1 CHE
4、N wei heng2（1.Guiyang College of Traditional Chinese Medicine,Guiyang,550002,China;2.Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing,100102,China）【Abstract】 Objective: To summarize and analyze related influencing factors of the efficacy of TCM hip-preserving in early-to-middle
5、 stage non-traumatic osteonecrosis of the femoral head (ONFH). Methods: Thirty inpatients on TCM hip-preserving treatment at the Third Department of Osteoarthropathy, Wangjing Hospital, CACMS, were assigned to the aggravated group, who were followed up for early-to-middle stage (ARCO stage II-IIIa)
6、non-traumatic ONFH over a more than one-year period and diagnosed as aggravated by imageological findings. Additional 30 inpatients on the same treatment at the same hospital were assigned to the stable group, who were diagnosed as stable early-to-middle stage non-traumatic ONFH by imageological fin
7、dings. With Excel, clinical data of medical records were collected from both groups of patients using double entry and validation. Differences were compared between both groups with respect to age, gender, occupation, body mass index (BMI), course, drinking history, history of steroid use and factor
8、 of being on crutches. Results: Following TCM hip-preserving, among influencing factors of the efficacy of TCM hip-preserving in early-to-middle stage non-traumatic ONFH, there were no significant differences in age, BMI, male : female ratio and Harris scale at last follow-up between both groups. Th
9、e course was longer in the aggravated group than in the stable group 4.10 (2.09) vs. 2.66 (1.39) years; P0.05. There were 70% of patients were manual workers in the aggravated group compared with the stable group (43.3%) (P0.05). For incidence of pathogenesis of alcohol, the aggravated group was mar
10、kedly lower than the stable group (43.3% vs. 70%; P0.05). For incidence of pathogenesis of steroid use, the aggravated group was markedly higher than the stable group (56.7% vs. 30%; P0.05). Conclusion: Such factors as occupation, course, drinking history, history of steroid use and being on crutche
11、s have marked effects on hip-preserving in early-to-middle stage non-traumatic ONFH and need to be valued.Key Words: Non-traumatic; osteonecrosis of the femoral head; TCM hip-preserving; influencing factors of the efficacy股骨头坏死（Necrosis of femoral head，ONFH）具有发病率高、致残率高等特点，是医学界公认的难治性疾病之一。目前，针对ONFH，换髋
12、疗法虽能在短时间内有效改善症状及提高患者的生活质量，但其长期（20年）的疗效仍难以预料。因此，保髋疗法仍然是临床重要的治疗手段1。相关研究证实，以中医药治疗为主的保髋疗法虽然在早中期非创伤性ONFH的治疗上取得了一定成效2，但仍有部分患者的疗效较差，而影响其疗效的相关因素尚不明确。基于此，本研究主要就影响早中期非创伤性ONFH中医药保髋治疗疗效的相关因素进行分析，以期为中医药保髋疗法治疗早中期非创伤性ONFH提供一定的理论依据。1 资料与方法1.1 一般资料选取经中国中医科学院望京医院骨关节三科住院接受中医药保髋治疗，随访时间超过一年的早中期（ARCO II-IIIa期）非创伤性股骨头坏死，影
13、像学检查结果为加重的患者30例，设为加重组；随机选取同期在我科住院接受中医药保髋疗法且影像学检查结果稳定的早中期非创伤性ONFH患者30例，设为稳定组。加重组中，男20例，女10例，年龄24岁76岁，平均年龄（42.3611.09岁），平均随访时间4年。稳定组中，男24例，女6例，发病年龄25岁58岁，平均（38.439.03）岁，平均随访时间4年。1.2 诊断、分期、分型标准诊断标准参照Mont3等提出的诊断标准，分期标准依据参考国际骨循环学会（ARCO）标准4；中医分型标准参照北京地区中医常见病证诊疗常规5和股骨头坏死“三期四型”辨证方法6。1.3 纳入标准（1）临床病历资料完整；（2）加
14、重组：股骨头塌陷大于4mm，甚至关节增生退变，或行人工全髋关节置换术；（3）稳定组：治疗后股骨头形态与治疗前一致，且囊变区（坏死区）骨密度改善，呈现稳定状态，或治疗后ARCO分期改善。1.4 中医药保髋疗法采用健脾活骨方配合中药动脉灌注治疗7，即经对侧股动脉插管至患侧旋股内、外动脉，依次迅速注入0.9%氯化钠注射液100ml，丹参注射液30ml。健脾活骨方口服治疗，随证加减：疼痛严重伴舌紫暗、脉涩，加元胡、苏木；下肢酸胀，伴舌黄腻、脉滑，加黄柏、茵陈；肢体酸楚伴舌腻、脉弦，加滑石粉、木瓜；腰腿酸软伴舌淡、脉无力，加续断、狗脊。3个月为1疗程，服用2个疗程。1.5 随访内容及资料的收集通过Exc
15、el表格，采用双人双录，专人核对的方式，收集两组患者的临床病历资料，包括姓名、年龄、性别、职业、体重指数、病程、饮酒史、激素使用史、拄拐等，分析并比较两组患者在年龄、性别、职业、体重指数、病程、饮酒史、激素使用史、拄拐因素方面的差异性。1.6 统计学方法所有资料均采用SPSS 16.0统计软件进行数据处理，发病年龄等计量资料以XS）表示，经检验其符合正态分布，故两组间比较采用t检验；计数资料采用率（%）表示，两组间比较采用卡方检验或秩和检验；设置=0.05，当P0.05）。而加重组与稳定组在病程、职业比率比较上，差异有统计学意义（P0.05）。表1 两组患者年龄和体重指数比较（XS）组别例数（n）年龄（岁）体重指数（kg/m2）加重组3042.3611.0922.561.92稳定组3038.439.0322.511.93t-1.704-0.114P-0.1350.910表2 两组患者男女性别比率比较（%）组别例数（n）男性女性加重组3020(66.7%)10(33.3%)稳定组3024(80%) 6(20%)1）注：1）表示，与加重组比较，2=1.364，P=0.191，差异无统计学意义。
