[1]阎晓霞 任之强△ 赵志强 吴秀丽 李龙飞 谢亚威.富血小板血浆联合补肾活血方促进股骨头坏死骨囊性变修复的短期疗效研究[J].中国中医骨伤科杂志,2025,33(07):54-62.[doi:10.20085/j.cnki.issn1005-0205.250710 ]
　YAN Xiaoxia REN Zhiqiang ZHAO Zhiqiang WU Xiuli LI Longfei XIE Yawei.Study on the Short Term Efficacy of Platelet-Rich Plasma Combined with Bushen Huoxue Formula on Promoting the Repair of Necrotic Bone Cyst of Femoral Head[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2025,33(07):54-62.[doi:10.20085/j.cnki.issn1005-0205.250710 ]
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富血小板血浆联合补肾活血方促进股骨头坏死骨囊性变修复的短期疗效研究()

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第33卷
期数:
2025年07期
页码:
54-62
栏目:
临床研究
出版日期:
2025-07-15

文章信息/Info

Title:
Study on the Short Term Efficacy of Platelet-Rich Plasma Combined with Bushen Huoxue Formula on Promoting the Repair of Necrotic Bone Cyst of Femoral Head
文章编号:
1005-0205(2025)07-0054-09
作者:
阎晓霞1 任之强1△ 赵志强1 吴秀丽2 李龙飞2 谢亚威2
1河南省洛阳正骨医院(河南省骨科医院)(郑州,450016)
2 河南中医药大学
Author(s):
YAN Xiaoxia1 REN Zhiqiang1△ ZHAO Zhiqiang1 WU Xiuli2 LI Longfei2 XIE Yawei2
1Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Zhengzhou 450016,China; 2Henan University of Chinese Medicine,Zhengzhou 450046,China.
关键词:
股骨头缺血性坏死;  富血小板血浆;  骨囊性变;  中药
Keywords:
avascular necrosis of the femoral head;  platelet-rich plasma;  bone capsular changes;  Chinese herb
分类号:
R681.8
DOI:
10.20085/j.cnki.issn1005-0205.250710
文献标志码:
A
摘要:
目的:观察富血小板血浆(PRP)联合补肾活血方促进股骨头缺血性坏死(ONFH)患者骨囊性变修复的治疗效果。方法:选取2023年6月至2024年2月确诊为肾虚血瘀型股骨头缺血性坏死且CT表现为骨囊性变患者80例,采用随机数字表法分为两组,每组40例。中药组主要采用口服补肾活血方中药并辅助拄拐,中药+PRP组在中药组基础上,另采用超声引导下关节腔注射富血小板血浆,1次/月,连续注射3次及以上,两组患者均治疗6个月以上。分别于治疗第0,3,6个月随访,以视觉模拟量表(VAS)评分、Harris评分和CT骨囊性变转归(骨质填充、范围缩小或骨量不变或减少、范围不变或扩大)及股骨头塌陷率进行疗效评估。结果:两组患者治疗后各时间点VAS评分较治疗前显著降低,Harris评分明显升高,差异有统计学意义(P<0.05)。组间比较,VAS评分及Harris评分差异无统计学意义。末次随访显示,中药+PRP组骨囊性变内骨量增加、范围变小为24例(60.0%),高于中药组15例(37.5%),差异有统计学意义(χ2=4.053,P=0.044)。中药+PRP组与中药组股骨头塌陷率均为10%,差异无统计学意义(χ2=0.159,P=0.690)。40例采用中药+PRP治疗患者分层比较表明,骨囊性变内骨量增加、范围变小患者注射富血小板血浆(5.13±0.719)次,显著高于骨囊性变内骨量不变或减少、范围不变或扩大患者(3.42±0.654)次,差异有统计学意义(t=7.781,P<0.001)。Spearman等级相关分析表明,注射富血小板血浆次数与促进骨囊性变修复相关系数为0.784,两者之间的正相关关系显著(强相关,P<0.001)。注射富血小板血浆次数与股骨头塌陷相关系数为0.474,两者之间呈中度正相关(P=0.002)。股骨头囊性变与股骨头塌陷相关系数为0.408,两者之间呈中度正相关(P=0.009 2)。结论:富血小板血浆联合补肾活血方治疗股骨头缺血性坏死能够显著促进骨囊性变区域内骨量增加、缩小囊性变范围,并且注射富血小板血浆次数多的患者,骨囊性变修复好于注射次数较少的患者。然而,补肾活血方联合富血小板血浆对比单纯使用补肾活血方治疗股骨头缺血性坏死并未表现出更显著的降低股骨头塌陷风险,且反复多次注射富血小板血浆虽然有利于促进骨囊性变修复,但对于预防股骨头塌陷没有显示出明显的治疗作用,提示预防股骨头塌陷难以依赖单一治疗方式,需要采用综合策略。对于CT显示有骨囊性变的患者,采取补肾活血方联合富血小板血浆协同治疗以促进骨囊性变修复的策略,值得临床医生尝试应用。
Abstract:
Objective:To observe platelet-rich plasma(PRP)combined with Bushen Huoxue formula to promote the repair of bone capsular degeneration in patients with avascular necrosis of the femoral head(ONFH)and to evaluate the therapeutic effect.Methods:A total of 80 patients diagnosed with renal deficiency and blood stasis ONFH and CT showed bone capsular degeneration from June 2023 to February 2024 were randomly divided into two groups,with 40 cases in each group.On the basis of the traditional Chinese medicine(TCM)group,the TCM + PRP group also used ultrasound-guided intra-articular injection of PRP,once a month,at least 3 consecutive injections,and both groups were treated for more than 6 months.Follow-up visits were conducted at 0,3 and 6 months of treatment,respectively.Visual analogue scale(VAS)score,Harris score,CT bone capsule prognosis(bone filling,reduction of the extent or unchanged or reduced bone mass,unchanged or enlarged of the range)and the collapse rate of the femoral head were evaluated.Results:The VAS score of the two groups was significantly lower than that before treatment,and the Harris score was significantly higher than that before treatment,and the difference was statistically significant(P<0.05).There was no significant difference between VAS and Harris scores.The last follow-up showed that 24 cases(60%)of the TCM + PRP group had an increase in bone capsular degeneration and a smaller range,which was higher than that in the TCM group with 15 cases(37.5%),and the difference was statistically significant(χ2=4.053,P=0.044).The femoral head collapse rate was 10% between the TCM + PRP group and the TCM group,but there was no significant difference(χ2=0.159,P=0.690).The stratified comparison of 40 patients treated with TCM + PRP showed that the number of PRP injections(5.13±0.719)was significantly higher in patients with increased bone mass and reduced bone mass and expanded range in bone capsular(3.42±0.654)(t=27.781,P<0.001).Spearman grade correlation analysis showed that the correlation coefficient between the number of PRP injections and the promotion of bone capsular repair was 0.784,and the positive relationship between the two was significant(strong correlation,P<0.001).The correlation coefficient between the number of PRP injections and femoral head collapse was 0.474,and there was a moderate positive correlation between the two(P=0.002).The correlation coefficient between femoral head cyst change and femoral head collapse was 0.408,and there was a moderate positive correlation between the two(P=0.009 2).Conclusion:PRP combined with TCM in the treatment of ONFH can significantly promote the increase of bone mass and reduce the scope of cystic degeneration in the area of bone cystosis,and the repair of cystic changes in patients with more PRP injections is better than that in patients with fewer injections.However,compared with the treatment of ONFH alone,TCM combined with PRP does not show a more significant reduction in the risk of femoral head collapse,and although repeated injections of PRP are beneficial to promote the repair of bone capsular degeneration,they do not show a obvious therapeutic effect on the prevention of femoral head collapse,suggesting that the prevention of femoral head collapse is difficult to rely on a single treatment method,and a comprehensive strategy is required.Clinically,for patients with cystic bone changes shown by CT,the strategy of synergistic treatment of TCM combined with PRP to promote the repair of cystic bone changes is worthy of trial by clinicians.

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备注/Memo

备注/Memo:
基金项目:河南省科技攻关项目(232102310423)
河南省中医药科学研究专项课题(2024ZY2108,2024ZY2115)
△通信作者 E-mail:924981526@qq.com
更新日期/Last Update: 2025-07-15