本文選題：大轉(zhuǎn)子骨瓣 + 中藥內(nèi)服　； 參考：《南京中醫(yī)藥大學》2016年碩士論文

【摘要】：目的 通過臨床回顧性研究,對比分析帶股外側(cè)肌蒂大轉(zhuǎn)子骨瓣移植聯(lián)合補腎活血湯治療早中期股骨頭壞死與單純的手術(shù)治療的臨床療效,觀察保髖臨床療效,從而為中醫(yī)藥治療股骨頭壞死提供臨床依據(jù),提高保髖手術(shù)的成功率。方法選擇2010年02月～2014年02月本院收治的早中期股骨頭壞死54例(60髖),分成治療組、對照組兩組,其中治療組：采用帶股外側(cè)肌蒂大轉(zhuǎn)子骨瓣移植聯(lián)合補腎活血湯治療32髖；對照組：采用帶股外側(cè)肌蒂大轉(zhuǎn)子骨瓣移植治療28髖；觀察2組患者的臨床療效并進行比較,采用中華醫(yī)學會骨科分會百分比評價法對所有結(jié)果統(tǒng)計分析,進行療效評估,比較治療前與治療12個月的疼痛,功能,關(guān)節(jié)活動度及X線評分,并且比較兩組患者末次隨訪的百分比優(yōu)良率,從而分析其他因素對臨床療效的影響。結(jié)果根據(jù)治療一年的隨訪統(tǒng)計結(jié)果,兩組患者的髖關(guān)節(jié)疼痛均明顯減輕或消失,髖關(guān)節(jié)活動度及功能得到改善,治療前與治療一年時疼痛、功能、X線評分、總分數(shù)比較其差異性均有統(tǒng)計學意義(P0.05)。在治療一年的隨訪結(jié)果統(tǒng)計表中,治療組在疼痛評分、功能評分、X線評分以及總分顯著高于對照組,差異具有統(tǒng)計學意義(P0.05)；在治療一年時治療組優(yōu)良率81.2%,對照組優(yōu)良率71.4%,中藥治療組的優(yōu)良率明顯高于對照組；在治療一年時所有患者在不同年齡階段的優(yōu)良率分別為87.88%、70.37%,表明在中早期股骨頭壞死的年輕患者效果更好；在治療一年時兩組患者在JIC分型A-B型的優(yōu)良率分別為90.9%、80%,在C1-C2型的優(yōu)良率分別為60%、50%,表明：外側(cè)柱越完整,股骨頭壞死的保髖臨床療效就越好。在治療一年時兩組患者在ARCOⅡA-ⅡC期的優(yōu)良率分別為95.45%、84.21%,在ARCOⅢA-ⅢB期的優(yōu)良率分別為50%、44.44%,說明股骨頭壞死的分期越早,效果越好,隨著分期的進展臨床效果越來越差。結(jié)論帶股外側(cè)肌蒂大轉(zhuǎn)子骨瓣移植聯(lián)合補腎活血湯治療早中期股骨頭壞死臨床療效顯著,能夠提高早中期股骨頭壞死患者的保髖成功率,改善股骨頭壞死預后。
[Abstract]:Objective to compare and analyze the clinical effect of the transplantation of great trochanter bone flap with lateral femoral muscle pedicle and Bushen Huoxue decoction in treating necrosis of femoral head and simple operation in early and middle period through clinical retrospective study, and to observe the clinical effect of hip preservation. So as to provide the clinical basis for the treatment of femoral head necrosis and improve the success rate of hip-preserving surgery. Methods from February 2010 to February 2014, 54 cases (60 hips) with necrosis of femoral head were divided into treatment group and control group. 32 hips were treated with pedicled great trochanteric bone flap transplantation with lateral femoral muscle pedicle combined with Bushen Huoxue decoction. Control group: 28 hips were treated with pedicled greater trochanter bone flap with lateral femoral muscle pedicle, the clinical efficacy of the two groups was observed and compared, and all the results were statistically analyzed and evaluated by the percentage evaluation method of the Chinese Medical Association Orthopedic Branch. Pain, function, joint motion and X-ray score were compared before and after 12 months of treatment, and the percentage of excellent and good rates of the last follow-up were compared between the two groups, so as to analyze the effect of other factors on the clinical efficacy. Results according to the results of follow-up for one year, the pain of hip joint in both groups was obviously alleviated or disappeared, the motion and function of hip joint were improved, the pain and the score of functional X-ray were obtained before and after treatment for one year. The difference of total score was statistically significant (P0.05). In the statistical table of follow-up results for one year, the scores of pain, function, X-ray and total score in the treatment group were significantly higher than those in the control group (P0.05). The excellent and good rate was 81.2% in the treatment group and 71.4% in the control group. The excellent and good rate of the traditional Chinese medicine treatment group was significantly higher than that of the control group. The excellent and good rates of all patients at different ages were 87.88 and 70.37 respectively at one year, which indicated that the young patients with femoral head necrosis in the middle and early stage had better results. At one year after treatment, the excellent and good rates of the two groups in JIC typing A-B were 90.9 and 80, respectively, and the excellent and good rates in C1-C2 were 60 and 50, respectively. The results showed that the more complete the lateral column, the better the clinical efficacy of hip preservation in osteonecrosis of femoral head. The excellent and good rates of ARCO 鈪，

本文編號：2054833