【作者】 刘文源；

【导师】 王义生；

【作者基本信息】 郑州大学 ， 外科学（专业学位）， 2013， 硕士

【摘要】 背景股骨头坏死,多发生于青壮年,致残率较高,随着影像技术的发展,人们己认识到本病早期诊断与治疗的重要性。目前临床上治疗早期股骨头坏死的方法众多,疗效不一,各有利弊,至今尚无公认的、明确的有效阻断病变进程进而避免实施人工全髋置换的方法。目的探讨祖国传统中医药加用髓芯减压干细胞移植对早期股骨头坏死的影响及疗效。本研究旨在利用中医活血化瘀、祛痰燥湿、补肝益肾类疗法及中药对早期股骨头坏死Ⅰ期、Ⅱ期患者髓芯减压干细胞移植增加骨修复的能力,进而论证祖国中医药学能干预股骨头坏死的自然进程,对推迟人工关节置换时间有确切疗效。方法自2008年8月至2011年3月,随机选择郑州大学第一附属医院骨科住院拟接受髓芯减压干细胞移植术的早期股骨头坏死患者100名,划分为两组,每组50人。一组为治疗组,一组为对照组。治疗组50例(78髋),其中男32例(57髋),女18例(21髓),平均年龄34.5(16-46)岁。根据国际骨循环研究学会ARCO的骨坏死分期标准：Ⅰ B期11例14髋,Ⅱ A期19例31髋,ⅡB期20例33髋；病因分类：皮质激素性髋38,酒精性34髋,特发性6髋。对照组50例(70髋),其中男35例(52髋),女15例(18髋),平均年龄37.5(18～49)岁。根据ARCO)骨坏死分期：Ⅰ B期13例15髋,Ⅱ A期19例28髋,Ⅱ B期18例27髋；病因分类：皮质激素性34髋,酒精性32髋,特发性4髋。治疗组行中药内服加用髓芯减压干细胞移植治疗,对照组仅行髓芯减压干细胞移植治疗。结果所有患者均获随访10～32个月,平均16.5个月。随访1～12个月者有58例87髋,随访12～24个月者有42例61髋。两组患者在疼痛与功能指标改善最明显,较术前较明显改善,且治疗组手术前后临床疗效改善较对照组明显,P<0.05有统计学意义。治疗组随访1～12个月、大于12个月的患者,术前疼痛平均11.03分、12.20分分别增加至术后平均18.21分、24.65分,关节活动度指标变化由术前平均10.10分、12.58分分别增加至术后平均16.12分、16.78分。X线指标由术前平均14.24分、13.96分增加至术后平均19.07分、27.76分,随访结果百分疗效显示,优14例,良24例,可3例,差4例,优良率为76.0%。随访综合临床疗效显示,治愈18例,显效25例,好转7例,总有效率86%。治疗前后MRI坏死体积比评价由术前平均33.60%降至术后平均11.28%。对照疗组随访1～12个月、大于12个月的患者,术前疼痛平均11.45分、13.20分分别增加至术后平均15.96分、19.01分,关节活动度指标变化由术前平均11.75分、12.11分分别增加至术后平均15.43分、15.67分。X线指标由术前平均11.83分、12.58分增加至术后平均16.87分、18.09分,随访结果百分疗效显示,优12例,良22例,可7例,差9例,优良率为68.0%。随访综合临床疗效显示,治愈11例,显效16例,好转23例,总有效率72%。治疗前后MRI坏死体积比评价由术前平均30.42%降至术后平均13.68%。治疗组有2例出现浅表感染,对照组有3例出现浅表感染,均经局部换药治愈。治疗组有3例口服中药后,出现胃脘部不适感,经调整服药时间及保护胃粘膜药物应用后,症状消失。结论中医药防治ONFH在动物模型实验研究治疗机制以及临床复方制剂方面逐步深入,并得到临床疗效认可。通过中西结合,运用中药内服配合减压干细胞移植可扭转股骨头缺血状态,增进头内微循环,通过降低骨内压,促进骨细胞、骨小梁修复,提高骨强度,阻止股骨头变形,在早期防治方面显示出一定的优势。本课题选用股骨头坏死临床最为见的气滞血瘀、痰湿两个证型,进行中药内服髓芯减压干细胞移植研究,临床疗效优于单纯髓芯减压干细胞组,近期效果较好改善症状,推迟了中青人髋关节转换时间,。通过中西结合研究治疗,为早期股骨头坏死的诊治开创了新的治疗方向和途径。更多还原

【Abstract】 BackgroundMainly young adults, femoral head necrosis, morbidity is higher, with the development of video technology, people have realized the importance of early diagnosis and treatment of this disease. Current clinical treatment of early avascular necrosis of the numerous methods, curative effect is different, each have advantages and disadvantages, so far there is no recognized, the clear effective block lesion process to avoid the implementation of artificial total hip replacement.ObjectiveTo explore Chinese medicine and traditional Chinese with medullary core decompression stem cell transplantation for early avascular necrosis influence and curative effect. This study aims to use traditional Chinese medicine promoting blood circulation to remove blood stasis, eliminating phlegm eliminating dampness, tonifying liver and benefiting kidney kind of therapy of traditional Chinese medicine and for early avascular necrosis I period, II period in patients with medullary core decompression stem cell transplantation increase bone repair ability, the thesis demonstrates the motherland traditional Chinese medicine (TCM) can intervention avascular necrosis of the natural process, to postpone the artificial joint replacement time curative effects. MethodsFrom August2008to March2011, random selection of the first affiliated hospital of zhengzhou university orthopaedic hospital intends to accept pulp core decompression stem cell transplantation in patients with ischemic necrosis of femoral head in the early100, divided into two groups, each group of50people. One group of treatment group, a group as control group. Treatment group in50cases (78hips), the male32cases (57hips), female18cases (21hip), with a mean age of34.5(16～46) years old. According to the international bone cycle research society of osteonecrosis ARCO installment standard:I B period of11cases of14hips, II A period19cases and hip, II B period20cases and hip,; Etiology classification:cortical hormone sex hip38, alcoholic and hip, idiopathic6hip. Control group of50cases (70hips), the male35patients (52hips), female15cases (18hip), with a mean age of37.5(18～49years old. According to ARCO) osteonecrosis installment:I B stage13cases of15hips,, II A period (19cases) and hip, II B period18cases of27hips; Etiology classification:cortical hormone sex and hip, alcoholic and hip, idiopathic4hips. The treatment group line of oral medicine add a pulp core decompression stem cell transplantation treatment group, only do medullary core decompression stem cell transplantation treatment.resultsAll of the patients have been followed up10～32months, an average of16.5months. Follow-up of1～12months’58cases87hip12～24months’follow-up, who have42cases of61hip. Two groups of patients in pain and improve the most obvious function indexes, the preoperative is obviously improved, and the treatment group before and after surgery to improve clinical curative effect is obvious in control group, P＜0.05have statistical significance. Follow-up treatment group1～12months, more than12months of patients, preoperative pain an average of11.03points and12.20points respectively to increase the average18.21points,24.65points, joint activity index change by preoperative an average of10.10points and12.58points respectively to increase the average16.12points,16.78points. X line index by preoperative an average of14.24points,13.96points to increase the average19.07points,27.76points and follow-up results percentage curative effect shows that optimal in14cases, and good24cases,3cases, and sent4cases, the excellent-good rate is76.0%. Follow-up integrated clinical curative effect shows that cure18cases, powerfully25cases,7cases improved, with the total effective rate86%. Before and after treatment MRI necrosis volume ratio evaluation by preoperative average33.60%to postoperative an average of11.28%. Control therapy group follow-up of1～12months, more than12months of patients, preoperative pain an average of11.45points and13.20points respectively to increase the average15.96points,19.01points, joint activity index change by preoperative an average of11.75points and12.11points respectively to increase the average15.43points,16.87points. X line index by preoperative an average of11.83points,12.58points to increase the average16.87points,18.09points and follow-up results percentage curative effect shows that optimal in12cases, good22cases,7cases,9cases of difference, the excellent-good rate is68.0%. Follow-up integrated clinical curative effect shows,11cases were cured,16cases (p＜, improvement in23cases, the total effective rate72%. Before and after treatment MRI necrosis volume ratio evaluation by preoperative average30.42%to postoperative an average of13.68%. The treatment group have2cases with superficial infection, control group have3cases with superficial infection, both by local dressing change cure. The treatment group3cases were treated by traditional Chinese medicine, the appear of epigastric discomfort, the adjustment medication time and protecting gastric mucosa drug application, the symptoms disappear.ConclusionThe prevention and control of ONFH traditional Chinese medicine has a long history, clinical treatment has accumulated rich experience, from the experiment of animal model research and treatment mechanism to clinical compound preparation gradually get satisfied curative effect, oral medicine fit decompression can turn thigh bone ischemia condition, improve microcirculation in the head, by decreasing the bone internal pressure, promote bone cells, bone trabecular repair, improve bone strength, prevent deformation of femoral head, in the early prevention and show a certain advantage.This topic selection of femoral head necrosis clinical most seen stagnancy of qi and blood stasis and phlegm wet two card type, pulp core decompression stem-cell research, clinical curative effect is better than that of pure though pulp core decompression stem cell group, recent effect is good to improve symptoms, postponed the middle man hip conversion time, through the Chinese and western combined with research and treatment for early diagnosis and treatment of ischemic necrosis femoral head a new therapeutic direction and the way.更多还原