Objective:To observe the clinical results and therapeutic characteristics of Tongluo Shenggu Decoction in the treatment of ARCOⅡnon-traumatic femoral head necrosis.Methods:120 patients with ARCOⅡnon-traumatic femora...Objective:To observe the clinical results and therapeutic characteristics of Tongluo Shenggu Decoction in the treatment of ARCOⅡnon-traumatic femoral head necrosis.Methods:120 patients with ARCOⅡnon-traumatic femoral head necrosis from January 2016 to January 2017 were studied by prospective matched and controlled design.60 cases in the treatment group were treated with Tongluo Shenggu Formula.The control group(60 cases)received high energy extracorporeal shock wave therapy.The imaging stability rate,Harris score and SF-36 score were used as clinical efficacy indicators,followed up for 24 months,and the follow-up results were statistically analyzed.Results:Among the 120 patients,5 fell off and the rest were followed up.The imaging stability rate is heavy.The imaging stability rate of the patients in the treatment group is 78.95%,while that in the control group is 72.41%.The two groups have the same stability rate(P>0.05).In Harris score,the Harris score of the patients in the treatment group was 92.678.45 points,significantly higher than that of the control group(80.3924.65 points),the difference was statistically significant(p<0.05),and the pain degree,joint function and joint deformity score of the treatment group were better than those of the control group(p<0.05).In the SF-36 score,the scores of physiological function,physiological function,physical pain,overall health,social function and emotional function in the treatment group were significantly higher than those in the control group,the difference was statistically significant(p<0.05).the incidence of adverse events in the treatment period of the two groups was lower and the patients could relieve themselves in the later stage.Conclusion:Tongluo Shenggu prescription has definite curative effect in treating ARCOⅡnon-traumatic femoral head necrosis,especially in improving hip joint function,relieving hip joint pain and improving quality of life.To observe the clinical results and therapeutic characteristics of Tongluo Shenggu Decoction in the treatment of ARCOⅡnon-traumatic femoral head necrosis.Methods:120 patients with ARCOⅡnon-traumatic femoral head necrosis from January 2016 to January 2017 were studied by prospective matched and controlled design.60 cases in the treatment group were treated with Tongluo Shenggu Formula.The control group(60 cases)received high energy extracorporeal shock wave therapy.The imaging stability rate,Harris score and SF-36 score were used as clinical efficacy indicators,followed up for 24 months,and the follow-up results were statistically analyzed.Results:Among the 120 patients,5 fell off and the rest were followed up.The imaging stability rate is heavy.The imaging stability rate of the patients in the treatment group is 78.95%,while that in the control group is 72.41%.The two groups have the same stability rate(P>0.05).In Harris score,the Harris score of the patients in the treatment group was 92.678.45 points,significantly higher than that of the control group(80.3924.65 points),the difference was statistically significant(p<0.05),and the pain degree,joint function and joint deformity score of the treatment group were better than those of the control group(p<0.05).In the SF-36 score,the scores of physiological function,physiological function,physical pain,overall health,social function and emotional function in the treatment group were significantly higher than those in the control group,the difference was statistically significant(p<0.05).the incidence of adverse events in the treatment period of the two groups was lower and the patients could relieve themselves in the later stage.Conclusion:Tongluo Shenggu prescription has definite curative effect in treating ARCOⅡnon-traumatic femoral head necrosis,especially in improving hip joint function,relieving hip joint pain and improving quality of life.展开更多
背景:股骨头坏死是骨科难治性疾病之一,不同分期、分型下的股骨头坏死自然塌陷病程影响着该病的进展及预后。目的:探究不同中日友好医院(China-Japan Friendship Hospital,CJFH)分型下国际骨循环研究协会(Association Research Circulat...背景:股骨头坏死是骨科难治性疾病之一,不同分期、分型下的股骨头坏死自然塌陷病程影响着该病的进展及预后。目的:探究不同中日友好医院(China-Japan Friendship Hospital,CJFH)分型下国际骨循环研究协会(Association Research Circulation Osseous,ARCO)Ⅱ期股骨头坏死未塌陷患者5年内自然塌陷病程,并分析不同CJFH分型的股骨头塌陷率及塌陷风险。方法:回顾性选取2016年10月至2017年10月在西安交通大学附属红会医院门诊确诊为ARCOⅡ期股骨头坏死未塌陷的患者为研究对象,根据是否塌陷将患髋分为塌陷组(n=82)和未塌陷组(n=70),统计不同CJFH分型的股骨头塌陷风险以及5年内塌陷时间、塌陷数量和塌陷率,并绘制不同CJFH分型股骨头的Kaplan-Meier生存曲线图。结果与结论:①共纳入患者97例,152髋,随访期间有82髋塌陷,总塌陷率为53.9%,其中M型、C型、L1型、L2型和L3型塌陷率分别为0.0%,36.7%,51.4%,72.2%和77.8%,各组间比较差异有显著性意义(P<0.05);②在塌陷风险方面,L1型塌陷风险为C型的1.704倍(P>0.05),而L2型、L3型塌陷风险分别为C型的3.866倍、6.423倍(P<0.05);③在Kaplan-Meier生存曲线方面,ARCOⅡ期患者股骨头中位生存时间为3年,95%置信区间为2.885-3.471年,第1,3,5年股骨头生存率分别为65.1%(99/152),50.7%(77/152),46.1%(70/152);④结果表明,不同CJFH分型影响着ARCOⅡ期股骨头坏死患者的塌陷率,其中L3型患者塌陷率最高,L2型和L1型患者次之,C型患者塌陷率较低,M型患者无塌陷,这表明股骨头外侧柱的保留对股骨头坏死自然塌陷病程有重要意义。展开更多
目的分析ARCO不同分期内单侧股骨头缺血坏死(osteonecrosis of the femoral head,ONFH)患者双侧坐骨股骨间隙(ischiofemoral space,IFS)的变化情况。材料与方法回顾性分析57例单侧ONFH患者(试验组)、25例健康志愿者(对照组)的双侧髋关节...目的分析ARCO不同分期内单侧股骨头缺血坏死(osteonecrosis of the femoral head,ONFH)患者双侧坐骨股骨间隙(ischiofemoral space,IFS)的变化情况。材料与方法回顾性分析57例单侧ONFH患者(试验组)、25例健康志愿者(对照组)的双侧髋关节MRI图像,按照ARCO标准将单侧ONFH患者进行分期,测量所有髋关节的IFS、股方肌间隙(quadratus femoris space,QFS)和颈干角(cervicodiaphyseal angle,CCD)。应用Kruskal-Wallis one-way test检验检测对照组髋关节、试验组股骨头坏死侧髋关节及试验组正常侧髋关节IFS、QFS、CCD的差别,应用配对t检验检测试验组内双侧髋关节间IFS、QFS、CCD的差别。结果试验组正常侧IFS[(21.16±7.09)mm]、QFS[(12.36±6.82)mm]小于对照组[IFS:(26.04±6.15)mm,QFS:(20.01±7.09)mm]及试验组坏死侧[IFS:(25.18±5.50)mm,QFS:(19.52±5.31)mm],试验组正常侧CCD[(137.74±3.88)°]大于对照组[(131.02±5.01)°]及试验组坏死侧[(132.40±7.05)°],差异均有统计学意义;试验组坏死侧IFS、QFS及CCD与对照组均无差别。57例单侧ONFH患者中ARCOⅠ期10例、Ⅱ期17例、Ⅲ期18例、Ⅳ期12例。ARCOⅠ、Ⅱ期的股骨头正常侧IFS[(17.49±6.33)mm(Ⅰ期)、(24.24±7.29)mm(Ⅱ期)]、QFS[(12.46±6.42)mm(Ⅰ期)、(14.93±6.78)mm(Ⅱ期)]、CCD[(134.56±6.06)°(Ⅰ期)、(131.94±9.08)°(Ⅱ期)]与坏死侧[(Ⅰ期IFS:(22.34±5.31)mm,QFS:(16.04±5.21)mm,CCD:(135.16±7.62)°;Ⅱ期IFS:(25.32±7.25)mm,QFS:(19.64±5.29)mm,CCD:(132.06±5.88)°]均无差别;而ARCOⅢ期的股骨头正常侧IFS[(19.76±7.97)mm]、QFS[(14.93±6.78)mm]均小于坏死侧IFS[(24.47±6.26)mm]、QFS[(19.64±5.29)mm],正常侧CCD[(135.76±5.70)°]大于坏死侧[(129.64±2.42)°];ARCOⅣ期的股骨头正常侧IFS[(23.17±6.86)mm]、QFS[(17.11±7.33)mm]亦均小于坏死侧IFS[(28.57±5.23)mm]、QFS[(22.88±6.24)mm],正常侧CCD[(137.63±7.62)°]大于坏死侧[(132.76±6.05)°]。结论单侧ARCOⅢ、Ⅳ期ONFH患者的正常侧髋关节IFS和QFS会减小,其并发坐骨股骨撞击综合征(ischiofemoral impingement,IFI)的风险较大。展开更多
目的:股骨头坏死(osteonecrosis of the femoral head,ONFH)又被称为股骨头缺血性坏死,多数患者并发脂肪代谢紊乱。本研究探讨不同亚型的ONFH的脂代谢表达谱模式。方法:将受试者分为酒精性股骨头坏死(alcohol-induced osteonecrosis of ...目的:股骨头坏死(osteonecrosis of the femoral head,ONFH)又被称为股骨头缺血性坏死,多数患者并发脂肪代谢紊乱。本研究探讨不同亚型的ONFH的脂代谢表达谱模式。方法:将受试者分为酒精性股骨头坏死(alcohol-induced osteonecrosis of the femoral head,AONFH)组(n=16)、激素性股骨头坏死(steroid-induced osteonecrosis of the femoral head,SONFH)组(n=29)、正常对照(normal control,NC)组(n=32)。运用超高效液相色谱-质谱/质谱串联(ultra high performance liquid chromatography-mass spectrometry/mass spectrometry tandem apparatus,UPLC-MS/MS)技术对受试者的外周血标本进行脂质代谢物的检测,鉴定疾病潜在的生物标志物。对代谢物表达谱进行预处理,再通过偏最小二乘法判别分析(partial least squares discriminant analysis,PLS-DA)计算变量投影重要度(variable importance for the projection,VIP)来衡量各脂质代谢物的表达模式对各组样本分类判别的影响强度和解释能力。筛选出不同组间倍数改变(fold change,FC)>2、P<0.05且VIP>1的脂质代谢物作为差异脂质物。其中,AONFH组和SONFH组中共同存在的差异脂质物被视为ONFH的共有差异脂质物,单独存在的差异脂质物被视为AONFH组或SONFH组的特异性差异脂质物。在差异脂质物的受试者操作特征(receiver operator characteristic,ROC)曲线分析的基础上,采用二元logistic回归评价差异脂质物对疾病的诊断价值。依据AONFH组和SONFH组患者的疾病分期信息,分析差异脂质物与疾病分期之间的相关性。结果:在血浆样本中共检测到1358种脂质代谢物。与NC组相比,AONFH组和SONFH组脂质代谢谱表达模式均有显著差异。分别在AONFH组和SONFH组患者外周血中筛选出62和64种差异脂质物(FC>2,P<0.05,VIP>1),且均以上调为主。进一步鉴定出AONFH组和SONFH组共有的差异脂质物有9种,AONFH组有6种脂质物的ROC曲线下面积大于0.7,它们分别为1-myristoyl-2-docosahexaenoyl-sn-glycero-3-phosphocholine、次黄嘌呤(hypoxanthin)、血清素(serotonin)、PE(19:0/22:5)、PE(19:0/22:5)、cholest-5-en-3-yl beta-Dglucopyranosiduronic acid;AONFH组鉴定出特异性差异脂质物53种。SONFH组鉴定出特异性差异脂质物55种,SONFH组有6种脂质物的曲线下面积大于0.9,分别为1D-myo-Inositol 1,2-cyclic phosphate、L-pyroglutamic acid、DL-carnitine、8-amino-7-oxononanoic acid、Clobetasol和presqualene diphosphate。AONFH组中有9种差异脂质代谢物与疾病分期有关,分别为LPG 18:1、serotonin、PC(22:4e/23:0)、PC(19:2/18:5)、hypoxanthin、PE(18:1/20:3)、LPE18:1、1-stearoyl-2-arachidonoyl-sn-glycerol、PE(16:0/18:1);随着AONFH疾病分期由Ⅰ/Ⅱ期向Ⅲ/Ⅳ期进展,该9种差异脂质物含量呈升高趋势。SONFH组中有8种差异脂质代谢物与疾病分期有关,分别为TM6076000、4-(1,1-dimethylpropyl)phenol、D-617、asarone、phenylac-gln-OH、肌酸(creatine)、leu-pro、8-amino-7-oxononanoic acid;随着SONFH疾病分期由Ⅰ/Ⅱ期向Ⅲ/Ⅳ期进展,该8种差异脂质物含量逐渐升高。结论:本研究分析了临床工作中常见AONFH和SONFH患者的血浆脂质表达谱特征,鉴定出了与疾病诊断及病情评估有关的差异脂质物,为探索ONFH的脂质代谢变化和挖掘新型敏感性、特异性生物标志物提供了依据。展开更多
基金Science foundation for postdoctoral researches in China(2017 M613179)Studio construction project of Traumatology and orthopedics of traditional Chinese medicine Guo family genre([2018]40)
文摘Objective:To observe the clinical results and therapeutic characteristics of Tongluo Shenggu Decoction in the treatment of ARCOⅡnon-traumatic femoral head necrosis.Methods:120 patients with ARCOⅡnon-traumatic femoral head necrosis from January 2016 to January 2017 were studied by prospective matched and controlled design.60 cases in the treatment group were treated with Tongluo Shenggu Formula.The control group(60 cases)received high energy extracorporeal shock wave therapy.The imaging stability rate,Harris score and SF-36 score were used as clinical efficacy indicators,followed up for 24 months,and the follow-up results were statistically analyzed.Results:Among the 120 patients,5 fell off and the rest were followed up.The imaging stability rate is heavy.The imaging stability rate of the patients in the treatment group is 78.95%,while that in the control group is 72.41%.The two groups have the same stability rate(P>0.05).In Harris score,the Harris score of the patients in the treatment group was 92.678.45 points,significantly higher than that of the control group(80.3924.65 points),the difference was statistically significant(p<0.05),and the pain degree,joint function and joint deformity score of the treatment group were better than those of the control group(p<0.05).In the SF-36 score,the scores of physiological function,physiological function,physical pain,overall health,social function and emotional function in the treatment group were significantly higher than those in the control group,the difference was statistically significant(p<0.05).the incidence of adverse events in the treatment period of the two groups was lower and the patients could relieve themselves in the later stage.Conclusion:Tongluo Shenggu prescription has definite curative effect in treating ARCOⅡnon-traumatic femoral head necrosis,especially in improving hip joint function,relieving hip joint pain and improving quality of life.To observe the clinical results and therapeutic characteristics of Tongluo Shenggu Decoction in the treatment of ARCOⅡnon-traumatic femoral head necrosis.Methods:120 patients with ARCOⅡnon-traumatic femoral head necrosis from January 2016 to January 2017 were studied by prospective matched and controlled design.60 cases in the treatment group were treated with Tongluo Shenggu Formula.The control group(60 cases)received high energy extracorporeal shock wave therapy.The imaging stability rate,Harris score and SF-36 score were used as clinical efficacy indicators,followed up for 24 months,and the follow-up results were statistically analyzed.Results:Among the 120 patients,5 fell off and the rest were followed up.The imaging stability rate is heavy.The imaging stability rate of the patients in the treatment group is 78.95%,while that in the control group is 72.41%.The two groups have the same stability rate(P>0.05).In Harris score,the Harris score of the patients in the treatment group was 92.678.45 points,significantly higher than that of the control group(80.3924.65 points),the difference was statistically significant(p<0.05),and the pain degree,joint function and joint deformity score of the treatment group were better than those of the control group(p<0.05).In the SF-36 score,the scores of physiological function,physiological function,physical pain,overall health,social function and emotional function in the treatment group were significantly higher than those in the control group,the difference was statistically significant(p<0.05).the incidence of adverse events in the treatment period of the two groups was lower and the patients could relieve themselves in the later stage.Conclusion:Tongluo Shenggu prescription has definite curative effect in treating ARCOⅡnon-traumatic femoral head necrosis,especially in improving hip joint function,relieving hip joint pain and improving quality of life.
文摘目的:股骨头坏死(osteonecrosis of the femoral head,ONFH)又被称为股骨头缺血性坏死,多数患者并发脂肪代谢紊乱。本研究探讨不同亚型的ONFH的脂代谢表达谱模式。方法:将受试者分为酒精性股骨头坏死(alcohol-induced osteonecrosis of the femoral head,AONFH)组(n=16)、激素性股骨头坏死(steroid-induced osteonecrosis of the femoral head,SONFH)组(n=29)、正常对照(normal control,NC)组(n=32)。运用超高效液相色谱-质谱/质谱串联(ultra high performance liquid chromatography-mass spectrometry/mass spectrometry tandem apparatus,UPLC-MS/MS)技术对受试者的外周血标本进行脂质代谢物的检测,鉴定疾病潜在的生物标志物。对代谢物表达谱进行预处理,再通过偏最小二乘法判别分析(partial least squares discriminant analysis,PLS-DA)计算变量投影重要度(variable importance for the projection,VIP)来衡量各脂质代谢物的表达模式对各组样本分类判别的影响强度和解释能力。筛选出不同组间倍数改变(fold change,FC)>2、P<0.05且VIP>1的脂质代谢物作为差异脂质物。其中,AONFH组和SONFH组中共同存在的差异脂质物被视为ONFH的共有差异脂质物,单独存在的差异脂质物被视为AONFH组或SONFH组的特异性差异脂质物。在差异脂质物的受试者操作特征(receiver operator characteristic,ROC)曲线分析的基础上,采用二元logistic回归评价差异脂质物对疾病的诊断价值。依据AONFH组和SONFH组患者的疾病分期信息,分析差异脂质物与疾病分期之间的相关性。结果:在血浆样本中共检测到1358种脂质代谢物。与NC组相比,AONFH组和SONFH组脂质代谢谱表达模式均有显著差异。分别在AONFH组和SONFH组患者外周血中筛选出62和64种差异脂质物(FC>2,P<0.05,VIP>1),且均以上调为主。进一步鉴定出AONFH组和SONFH组共有的差异脂质物有9种,AONFH组有6种脂质物的ROC曲线下面积大于0.7,它们分别为1-myristoyl-2-docosahexaenoyl-sn-glycero-3-phosphocholine、次黄嘌呤(hypoxanthin)、血清素(serotonin)、PE(19:0/22:5)、PE(19:0/22:5)、cholest-5-en-3-yl beta-Dglucopyranosiduronic acid;AONFH组鉴定出特异性差异脂质物53种。SONFH组鉴定出特异性差异脂质物55种,SONFH组有6种脂质物的曲线下面积大于0.9,分别为1D-myo-Inositol 1,2-cyclic phosphate、L-pyroglutamic acid、DL-carnitine、8-amino-7-oxononanoic acid、Clobetasol和presqualene diphosphate。AONFH组中有9种差异脂质代谢物与疾病分期有关,分别为LPG 18:1、serotonin、PC(22:4e/23:0)、PC(19:2/18:5)、hypoxanthin、PE(18:1/20:3)、LPE18:1、1-stearoyl-2-arachidonoyl-sn-glycerol、PE(16:0/18:1);随着AONFH疾病分期由Ⅰ/Ⅱ期向Ⅲ/Ⅳ期进展,该9种差异脂质物含量呈升高趋势。SONFH组中有8种差异脂质代谢物与疾病分期有关,分别为TM6076000、4-(1,1-dimethylpropyl)phenol、D-617、asarone、phenylac-gln-OH、肌酸(creatine)、leu-pro、8-amino-7-oxononanoic acid;随着SONFH疾病分期由Ⅰ/Ⅱ期向Ⅲ/Ⅳ期进展,该8种差异脂质物含量逐渐升高。结论:本研究分析了临床工作中常见AONFH和SONFH患者的血浆脂质表达谱特征,鉴定出了与疾病诊断及病情评估有关的差异脂质物,为探索ONFH的脂质代谢变化和挖掘新型敏感性、特异性生物标志物提供了依据。
