本文關(guān)鍵詞：骨髓水腫與股骨頭壞死中醫(yī)綜合保髖影像學(xué)變化的相關(guān)研究　出處：《廣州中醫(yī)藥大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 骨髓水腫 股骨頭壞死 保髖療法 影像學(xué)變化

【摘要】：目的：股骨頭壞死是骨科領(lǐng)域常見且難治的疾病,具有致殘率高、療效不佳、嚴(yán)重影響患者生活質(zhì)量的特點(diǎn)�，F(xiàn)有治療方法主要有保髖治療和人工關(guān)節(jié)置換。因股骨頭壞死好發(fā)于中青年,若過(guò)早行人工關(guān)節(jié)置換,患者可能面臨多次翻修手術(shù)。因此,股骨頭壞死早中期應(yīng)首選保髖治療。MRI顯示的骨髓水腫是股骨頭壞死病情發(fā)展過(guò)程中的伴隨現(xiàn)象,其發(fā)生機(jī)制尚不明確,且與股骨頭壞死保髖療效的相關(guān)研究偏少。本研究的目的是分析不同程度骨髓水腫對(duì)股骨頭壞死中醫(yī)綜合保髖治療后的影像學(xué)變化的影響,探究骨髓水腫的發(fā)生機(jī)制和尋找骨髓水腫出現(xiàn)時(shí)合適的保髖治療方法。方法：采用回顧性分析法,病例全部來(lái)源于2010年9月至2013年10月在廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院行中醫(yī)綜合保髖治療的股骨頭壞死的患者。按MRI顯示的骨髓水腫程度分為2大組,最終納入觀察病例53例73髖,其中輕度骨髓水腫41髖,重度骨髓水腫32髖。平均隨訪28.07±6.33個(gè)月(19-43個(gè)月)。分別對(duì)比兩組在年齡、性別、中醫(yī)證型、手術(shù)方式、股骨頭生存時(shí)間、末次隨訪的正位及蛙位股骨頭塌陷程度、術(shù)后股骨頭X線進(jìn)展(頭臼關(guān)系、關(guān)節(jié)穩(wěn)定)之間的差異。研究結(jié)果使用SPSS19.0進(jìn)行統(tǒng)計(jì)學(xué)處理,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果：不同證型組間的骨髓水腫程度差異有統(tǒng)計(jì)學(xué)意義,其中腎虛血瘀證組與痰瘀蘊(yùn)結(jié)證組間的骨髓水腫程度差異有統(tǒng)計(jì)學(xué)意義(P0.05),腎虛血瘀證組以輕度骨髓水腫為主27髖(73.0%),痰瘀蘊(yùn)結(jié)證組以重度骨髓水腫為主18髖(72.0%)。不同骨髓水腫程度的股骨頭,術(shù)后正位及蛙位進(jìn)一步塌陷的程度差異均有統(tǒng)計(jì)學(xué)意義(P0.05),輕度骨髓水腫組術(shù)后正位及蛙位進(jìn)一步塌陷程度較輕。微創(chuàng)手術(shù)組中,術(shù)后末次隨訪時(shí),不同骨髓水腫程度的股骨頭正位及蛙位進(jìn)一步塌陷的程度差異均有統(tǒng)計(jì)學(xué)意義(P0.05),輕度骨髓水腫組術(shù)后正位及蛙位進(jìn)一步塌陷程度較輕。輕度骨髓水腫組中,術(shù)后末次隨訪X線上,微創(chuàng)手術(shù)組與切開手術(shù)組比較,股骨頭的正位及蛙位進(jìn)一步塌陷程度、頭臼匹配關(guān)系、關(guān)節(jié)穩(wěn)定程度差異均有統(tǒng)計(jì)學(xué)意義(P0.05),微創(chuàng)手術(shù)組的術(shù)后正位及蛙位進(jìn)一步塌陷程度均顯著低于切開手術(shù)組,頭臼匹配關(guān)系、關(guān)節(jié)穩(wěn)定程度較切開手術(shù)組好。重度骨髓水腫組中,術(shù)后末次隨訪X線上,微創(chuàng)手術(shù)組與切開手術(shù)組比較,股骨頭蛙位進(jìn)一步塌陷及關(guān)節(jié)穩(wěn)定情況方面差異有統(tǒng)計(jì)學(xué)意義(P0.05),微創(chuàng)手術(shù)組的術(shù)后蛙位進(jìn)一步塌陷程度顯著低于切開手術(shù)組,關(guān)節(jié)穩(wěn)定程度較切開手術(shù)組好。骨髓水腫程度與年齡之間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),但重度骨髓水腫的年齡較輕度骨髓水腫的大。不同性別的骨髓水腫程度之間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。輕度和重度骨髓水腫的股骨頭生存率曲線之間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。切開手術(shù)組中,術(shù)后末次隨訪X線上,不同骨髓水腫程度的術(shù)后4項(xiàng)影像學(xué)觀察指標(biāo)差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：1、骨髓水腫是由股骨頭壞死修復(fù)中的機(jī)械應(yīng)力異常引起,其出現(xiàn)可能與股骨頭內(nèi)不穩(wěn)定,骨小梁應(yīng)力性骨折有關(guān)。2、骨髓水腫可影響股骨頭壞死保髖治療結(jié)局,嚴(yán)重骨髓水腫的治療結(jié)局比輕度骨髓水腫的差。3、當(dāng)出現(xiàn)嚴(yán)重骨髓水腫時(shí),應(yīng)及時(shí)干預(yù),減輕骨髓水腫,防止疾病進(jìn)一步惡化。
[Abstract]:Objective: the femoral head is a common Department of orthopedics and refractory disease, with high rate of disability, poor efficacy, seriously affect the characteristics of the quality of life of the patients. The existing treatment methods are mainly hip preserving treatment and artificial joint replacement for femoral head necrosis occurs in the youth, if too early artificial joint replacement, patients may face many times of revision surgery. Therefore, femoral head necrosis at early stage should be the first choice of hip preserving.MRI showed bone marrow edema is accompanied by the phenomenon of avascular necrosis of the femoral head during the progression of disease, its pathogenesis is still unclear, and the related research of ONFH curative effect is less. The purpose of this study is to analyze the impact of different degrees the changes of bone marrow edema in the treatment of osteonecrosis of integrated traditional Chinese Medicine Hip preserving stocks of the image, and find the mechanism of bone marrow edema appeared right hip preserving treatment of bone marrow edema. Methods: Using A retrospective analysis of femoral head necrosis were all treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine for integrated traditional Chinese medicine from September 2010 to October 2013 of the hip preserving patients. According to the degree of bone marrow edema MRI display, divided into 2 groups, included 53 cases were observed in 73 hips, 41 hips in the mild bone marrow edema, severe bone marrow edema in 32 hip. Average follow-up was 28.07 + 6.33 months (19-43 months) respectively. Comparing the two groups in age, gender, type of Chinese medicine, surgery, the femoral head survival time of the last follow-up anteroposterior and frog position degree of collapse of femoral head after operation of femoral head, progress of X-ray (femoral head, joint stability) the difference between the use of SPSS19.0. The results were analyzed statistically by P0.05, the difference was statistically significant. Results: there was significant difference in bone marrow edema in different syndrome groups, including kidney deficiency and blood stasis syndrome group and the phlegm and blood stasis stagnation syndrome group There was significant difference between the degree of bone marrow edema (P0.05), kidney deficiency and blood stasis in patients with mild bone marrow edema in 27 hips (73%), phlegm and blood stasis group with severe bone marrow edema in 18 hips (72%). The different degree of bone marrow edema of the femoral head, postoperative anteroposterior and frog position difference step the collapse had statistical significance (P0.05), mild bone marrow edema group postoperative anteroposterior and frog position further collapse to a lesser extent. Minimally invasive surgery group, the last follow-up after operation, the different degree of bone marrow edema of the femoral head in the anteroposterior and frog position differences in the degree of further collapse had statistical significance (P0.05), mild bone marrow edema group after operation anteroposterior and frog position further collapse to a lesser extent. Mild bone marrow edema group, postoperative follow-up X-ray, minimally invasive surgery group and open surgery group, the femoral head is a bit further and the frog collapse degree of femoral head, joint instability The degree of the differences were statistically significant (P0.05), minimally invasive surgery group postoperative anteroposterior and frog position further collapse degree were significantly lower than those in open surgery group, femoral head, joint stability is better than open surgery group. Severe bone marrow edema group, postoperative follow-up X-ray, minimally invasive and open surgery group the operation group, there was statistical significance of femoral head collapse and joint frog bit further stability difference (P0.05), minimally invasive surgery group after surgery was significantly lower than that in frog position further collapse incision group, the degree of stability is cut open joint surgery group. There was no significant difference between the degree of bone marrow edema with age (P0.05). But the age of severe bone marrow edema and mild bone marrow edema. There was no significant difference between the degree of bone marrow edema of different gender (P0.05). Mild and severe bone marrow edema of the femoral head survival rate curve There was no statistically significant difference (P0.05). Open surgery group, postoperative follow-up X-ray, different degree of bone marrow edema after surgery 4 imaging observation index showed no significant difference (P0.05). Conclusion: 1, bone marrow edema is caused by abnormal repair of femoral head necrosis in mechanical stress. It may appear in the femoral head and unstable bone related.2 small beam stress fracture, bone marrow edema can affect the treatment outcome of ONFH, severe bone marrow edema treatment outcome than mild bone marrow edema in.3, when a serious bone marrow edema, timely intervention, reduce bone marrow edema, to prevent further deterioration of the disease.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R274.9;R445.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 鄒海鵬;陳衛(wèi)衡;;中晚期股骨頭壞死中醫(yī)綜合治療的臨床研究[J];北京中醫(yī)藥;2010年01期

2 高振華;馬玲;臧建;孟悛非;;股骨頭壞死骨髓水腫與MRI分期相關(guān)性分析[J];中國(guó)CT和MRI雜志;2012年01期

3 何偉,袁浩,李雄,桂志紅,蔡振基,樊粵光,張德興,劉少軍;多條血管束植入治療成人股骨頭壞死的遠(yuǎn)期療效觀察(附190例203髖分析)[J];骨與關(guān)節(jié)損傷雜志;2000年04期

4 儲(chǔ)玉山;曹建民;孔偉東;高大志;盧光明;;非創(chuàng)傷性股骨頭缺血性壞死骨髓水腫的數(shù)字減影血管造影研究[J];醫(yī)學(xué)研究生學(xué)報(bào);2006年08期

5 劉毓;何偉;;何偉教授保髖治療股骨頭壞死塌陷晚期經(jīng)驗(yàn)介紹[J];新中醫(yī);2010年07期

6 趙培榮;莊奇新;喬瑞華;楊世勛;張長(zhǎng)青;;股骨頭缺血壞死骨髓水腫的MRI研究[J];實(shí)用放射學(xué)雜志;2006年07期

7 ;成人股骨頭壞死診療標(biāo)準(zhǔn)專家共識(shí)(2012年版)[J];中國(guó)骨與關(guān)節(jié)外科;2012年02期

8 李雄,袁浩;袁浩教授對(duì)股骨頭壞死中醫(yī)藥論治的學(xué)術(shù)思想[J];中國(guó)中醫(yī)骨傷科;1999年01期

9 李勇;何偉;張慶文;方斌;;不明原因股骨頭骨髓水腫臨床分析[J];中國(guó)中醫(yī)骨傷科雜志;2012年03期

10 何偉;李勇;張慶文;王海彬;龐智暉;曾平;袁浩;;股骨頭壞死修復(fù)反應(yīng)區(qū)的骨髓水腫及其病理改變[J];中華關(guān)節(jié)外科雜志(電子版);2008年01期

相關(guān)博士學(xué)位論文 前2條

1 龐智暉;股骨頭前外側(cè)柱與激素性股骨頭壞死預(yù)后和保髖療效的相關(guān)性研究[D];廣州中醫(yī)藥大學(xué);2008年

2 陳鎮(zhèn)秋;酒精性股骨頭壞死保髖療效的相關(guān)性研究[D];廣州中醫(yī)藥大學(xué);2009年

相關(guān)碩士學(xué)位論文 前1條

1 張銘杰;早期股骨頭壞死并發(fā)骨髓水腫的預(yù)后研究[D];廣州中醫(yī)藥大學(xué);2008年

，

本文編號(hào)：1440098