本文選題：針刀療法 + 股骨頭壞死　； 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過比較不同影響因素對(duì)針刀治療股骨頭壞死的療效差異,分析影響針刀療法改善股骨頭壞死患者關(guān)節(jié)功能的相關(guān)因素,為針刀治療股骨頭壞死提供理論依據(jù)和應(yīng)用參考,優(yōu)化股骨頭壞死的臨床治療方案,進(jìn)一步提高治療的療效。方法:選取來自于2014年2月至2015年6月在望京醫(yī)院骨關(guān)節(jié)三科住院接受針刀治療的股骨頭壞死病例,按照納入、排除標(biāo)準(zhǔn)最后納入研究的病例共50例,共75髖,脫落4例,5髖。設(shè)計(jì)統(tǒng)一標(biāo)準(zhǔn)的股骨頭壞死病例報(bào)告表。所有入組患者根據(jù)患者功能受限的程度及臨床癥狀,選擇性采用不同的針刀松解方法。主要有髖關(guān)節(jié)囊針刀松解、髖內(nèi)側(cè)針刀松解、髖外側(cè)松解。在治療后1周,2周,3個(gè)月,6個(gè)月后進(jìn)行臨床隨訪,每次隨訪均詳細(xì)填寫CRF表。CRF表錄入采用雙人雙錄,專人核對(duì)的方式。最后所得數(shù)據(jù)采用SPSS20.0統(tǒng)計(jì)學(xué)軟件包處理,設(shè)定P0.05具有有統(tǒng)計(jì)意義。分析針刀療法改善股骨頭壞死患者關(guān)節(jié)功能的療效并比較在職業(yè)、病因、病程、影像分期等相關(guān)因素的療效差異。結(jié)果:本研究隨訪資料滿半年的患者46例70髖。其中男性27例40髖,女性19例30髖。體力勞動(dòng)9例占19.57%,非體力勞動(dòng)20例占43.48%,無職業(yè)17例占36.95%;特發(fā)性股骨頭壞死17例占36.96%,創(chuàng)傷性股骨頭壞死2例占4.34%,激素性股骨頭壞死15例占32.61%,酒精性股骨頭壞死12例占26.09%;病程半年以內(nèi)15例占32.61%,半年到一年13例占28.26%,1年以上18例占19.13%;按ARCO股骨頭壞死分期標(biāo)準(zhǔn)進(jìn)行分期:其中Ⅱ期:20髖;Ⅲ期:33髖;Ⅳ期:17髖�？傮w結(jié)果顯示:針刀治療前后VAS評(píng)分:治療前4.65±1.303,治療后1周3.79±1.167(P0.05),.治療后6個(gè)月2.48±1.188(P0.05);Harris評(píng)分:治療前68.34±14.22,治療后3個(gè)月 83.04±12.79(P0.05),治療后 6 個(gè)月 85.18±10.49(P0.05);關(guān)節(jié)活動(dòng)度:治療前184.36±49.63,治療后1周227.14±35.16(P0.05),治療后6個(gè)月242.13±33.61(P0.05)。不同影像分期關(guān)節(jié)活動(dòng)度多重比較:1周隨訪時(shí),Ⅳ期與Ⅱ期對(duì)比患者關(guān)節(jié)活動(dòng)度改善了 44.206±10.941(P0.05),Ⅳ期與Ⅲ期對(duì)比患者關(guān)節(jié)活動(dòng)度改善了30.312±9.902(P0.05);6個(gè)月隨訪時(shí),Ⅳ期與Ⅱ期對(duì)比患者關(guān)節(jié)活動(dòng)度改善了 59.941±10.738(P0.05),Ⅳ期與Ⅲ期對(duì)比患者關(guān)節(jié)活動(dòng)度改善了 38.275±9.718(P0.05);結(jié)果示Ⅳ期比Ⅱ期、Ⅲ期的患者關(guān)節(jié)活動(dòng)度改善更加明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。VAS評(píng)分多重比較:在隨訪1周時(shí),Ⅱ期比Ⅲ期、Ⅳ期的患者疼痛程度改善更大;而在6個(gè)月隨訪時(shí)Ⅳ期比Ⅱ期、Ⅲ期的患者疼痛改善程度大,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。不同病因關(guān)節(jié)活動(dòng)度多重比較,激素性較特發(fā)性及酒精性的患者關(guān)節(jié)活動(dòng)度改善程度大,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。VAS評(píng)分多重比較,激素性較特發(fā)性及酒精性的患者疼痛改善程度大,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。不同病程關(guān)節(jié)活動(dòng)度多重比較,病程1年的患者關(guān)節(jié)活動(dòng)度改善更大,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。VAS評(píng)分多重比較,在1周隨訪時(shí)病程在6月-1年的患者疼痛程度改善情況比病程6月及1年的更好,而在隨訪6個(gè)月時(shí)病程1年的患者疼痛程度改善情況比病程6月-1年及6月的更好,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。不同職業(yè)類型關(guān)節(jié)活動(dòng)度多重比較,無職業(yè)的患者關(guān)節(jié)活動(dòng)度改善程度大,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。VAS評(píng)分多重比較,無職業(yè)的患者疼痛改善程度大,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.對(duì)于股骨頭壞死患者,針刀治療對(duì)緩解髖關(guān)節(jié)疼痛癥狀、改善關(guān)節(jié)活動(dòng)度具有良好的療效,尤其是在關(guān)節(jié)活動(dòng)功能改善方面更具有特色。2.術(shù)前的影像分期是影響針刀治療股骨頭壞死患者關(guān)節(jié)功能療效的重要的因素。3.采用針刀治療不論何種病因、病程長(zhǎng)短、何種職業(yè)的股骨頭壞死患者,均能有效的改善其疼痛及關(guān)節(jié)活動(dòng)度。
[Abstract]:Objective: To compare the effects of different influence factors on the treatment of femoral head necrosis with Acupotomy, analyze the related factors that affect the joint function of the patients with femoral head necrosis, provide the theoretical basis and application reference for the Acupotomy for the necrosis of the femoral head, optimize the clinical treatment plan of the femoral head necrosis, and further improve the therapeutic effect. Methods: a total of 50 cases of avascular necrosis of the femoral head were selected from February 2014 to June 2015 in the three families of bone and joint in Wangjing Hospital. A total of 75 hips, 4 cases and 5 hips were selected according to the inclusion and exclusion criteria. The degree and clinical symptoms were limited and the different needle knife loosening methods were selected. The main results were the loosening of the hip sacs, the loosening of the hip medial acupotomy, and the lateral release of the hip. 1 weeks, 2 weeks, 3 months, and 6 months after the treatment were followed up, and the CRF table.CRF was recorded in a double record, and the best way to check. The following data were processed by SPSS20.0 statistics software package, and P0.05 had statistical significance. The curative effect of needle knife therapy on the improvement of joint function in patients with femoral head necrosis was analyzed and the difference in the effect of related factors in occupation, etiology, course of disease, and image staging were compared. Results: 46 cases of 70 hips in this study were followed up for half a year. Among them, male 2 There were 40 hips in 7 cases, 19 cases of 30 hips in women, 19.57% in manual labor, 43.48% for non manual labor, 43.48% for non manual labor, 36.95% in no occupation, 17 in the femoral head necrosis of idiopathic femoral head 36.96%, traumatic femoral head necrosis in 2 cases, steroid femoral head necrosis and alcoholic femoral head necrosis within half a year. A year to one year 13 cases accounted for 28.26%, and more than 1 years 18 cases accounted for 19.13%. According to the ARCO staging of avascular necrosis of the femoral head, stage II: 20 hips, stage III, 33 hips, and 17 hips. Overall results showed that before and after acupotomy, the VAS score was 4.65 + 1.303, 1 weeks 3.79 + 1.167 (P0.05) after treatment. After treatment, Harris score: treatment: treatment: treatment The first 68.34 + 14.22, 3 months 83.04 + 12.79 (P0.05) after treatment, 6 months after treatment 85.18 + 10.49 (P0.05), joint activity: 184.36 + 49.63 before treatment, 227.14 + 35.16 (P0.05) after treatment, P0.05 after treatment. The mobility improved by 44.206 + 10.941 (P0.05). The joint activity of patients in stage IV and stage III was improved by 30.312 + 9.902 (P0.05). During the 6 month follow-up, the joint activity in stage IV and stage II was improved by 59.941 + 10.738 (P0.05), and the joint activity in stage IV and stage III was improved by 38.275 + 9.718 (P0.05), and the results showed stage IV than phase II, The improvement of joint activity in stage III patients was more obvious, and the difference was statistically significant (P0.05).VAS score: at 1 weeks of follow-up, the pain degree of patients in stage II was better than in stage III and stage IV, while in the 6 months follow-up period, the degree of pain in stage IV was larger than that in stage II, and there was no significant difference (P0.05). There was no statistically significant difference (P0.05).VAS score, and there was no significant difference in pain improvement between steroid and alcoholic patients (P0.05). There was no significant difference in the degree of joint activity in different course of disease (P0.05). The course of disease was 1 years. The patient's joint activity was improved more, with no statistically significant difference (P0.05).VAS score. At 1 weeks of follow-up, the improvement of pain was better than that in June and 1 years in the 1 week of June, and the degree of pain in patients with a 6 month follow-up of 1 years was better than that in the course of the course of the disease in June -1 and June. Statistical significance (P0.05). The joint activity of different occupational types was compared. There was no significant difference in the degree of improvement of joint activity in the non occupational patients (P0.05), and there was no significant difference (P0.05).VAS score. The pain improvement degree of the non occupational patients was large and the difference was not statistically significant (P0.05). Conclusion 1. for patients with femoral head necrosis, Acupotomy treatment is slow The symptoms of hip joint pain and the improvement of joint activity have good curative effect. Especially in the improvement of joint function, the image staging of.2. before operation is an important factor affecting the curative effect of the joint function of the patients with femoral head necrosis..3. using needle knife to treat the cause of the disease, the length of the disease, and what kind of occupation Patients with osteonecrosis can effectively improve their pain and joint mobility.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R246.9

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