The Seven Years Follow-up Study on Non-surgical Treatment of SARS Patients with Osteconecrosis
|School||China Academy of Traditional Chinese Medicine|
|Course||TCM orthopedics and traumatology|
|Keywords||Steroid-induced osteonecrosis of femoral head Retrospective cohort study TCM syndrome Diagnosis and treatment|
ObjectiveThis project is to explore the onset of the law and non-surgical treatment of the condition changes of steroid-induced osteonecrosis by the follow-up study of osteonecrosis of SARS patients after seven years, and to find the quality of life impact relevant factors based on "biological-psychological-social medical model"MethodFrom May 2003 to December 2010 Wangjing Hospital, China Academy of Chinese Medical Science in China, A Division of Wangjing hospitalized treatment of SARS patients with osteonecrosis, according to inclusion, exclusion criteria included subjects were 61 patients.Diagnosis and staging of osteonecrosis (1) the diagnostic criteria made as Mont. (2) Association Research Circulation Osseous, (ARCO) staging system.TCM syndrome type was collected by two high qualification Chinese doctors through the look, smell, and ask, touch, and the results entried as a database, consulting the "issued by TCM of Lung Cancer standard "and" common card in Beijing Traditional Chinese Medicine clinic routine, "the dialectical unity of dialectical standards developed by the State Administration of Traditional Chinese Medicine. Grouping method:(1) by non-surgical treatment,61 cases were divided into multiple channels of Chinese medicine treatment group (46 cases) and oral medicine symptomatic treatment group (15 cases) groups;(2) 61 cases of osteonecrosis patients after SARS,7 years later, TCM according to the total hormone dose group were divided into 26 small (<5000mg), middle dose group 25 (5000-10000mg) and high dose group of 10 people (>10000mg) three groups; (3) after 61 cases of osteonecrosis in patients with SARS,7 years after the imaging data, according to ARCO stage, as early as mid-term (ARCOⅠ,Ⅱ) 46 cases and late (ARCOⅢ,Ⅳ) 15 were divided into two groups; (4) 61 cases of osteonecrosis patients after SARS,7 years after the imaging data, grouped by necrosis area, based on necrosis area> 30%(45 cases) and "30%(16 cases) were divided into two groups. Application SPSS11.5 statistical package statistical processing, count data were analyzed by chi-square test; measurement data using t test; multi-factor analysis of variance used for the degree of osteonecrosis and osteonecrosis of the total area and the relationship between hormone. The distribution frequency of differentiation factor (percentage)=the sum of each dialectical factor÷the number of each group×100%; hierarchical clustering applied statistical software SPSS hierarchical cluster approach; The use of partial correlation analysis between Harris score and SF-36 quality of life scale score, P<0.05 was considered statistically significant.ResultsGeneral Information1.1 Follow-SARS osteonecrosis for seven years 61 patients,21 males,40 females; aged 29 to 79 years, mean 50.97±10.58 years; onset time of 128.88±36.85 (70～215) days. Glucocorticoids (equivalent to methylprednisolone) the total average of 6668.62±4934.61 (1460～28400) mg; glucocorticoid daily volume of 165.77±80.87 (46.86～376.47) mg; at most large was 403.44±225.90 (80～1180) mg, glucocorticoids the average duration of 50.02±24.91 (18～110) days.1.2 Treatment:The multiple channels of Chinese medicine treatment group (45 cases) and oral medicine symptomatic treatment group (16 cases) groups at baseline in gender, age, body mass index and the VAS is no significant statistical difference, P> 0.05.1.3 Lipid test:61 cases of osteonecrosis patients after SARS,7 years later, the four lipid test results showed, triglyceride (TG) minimum is 0.62mmol/L, maximum of 12.86 mmol/L, mean 2.04±2.43 mmol/L, abnormal rate 16.39%, total cholesterol (CHO) minimum is 1.05 mmol/L, maximum 9.87 mmol/L, mean 5.15±1.44 mmol /L, abnormal rate of 31.15%, high density apolipoprotein (HDL) minimum is 0.76 mmol/L, max 2.03 mmol/L, mean 1.22±0.25 mmol/L, abnormal rate of 4.90%, low density apolipoprotein (LDL) minimum is 1.52 mmol/L. maximum 7.30 mmol/ L. mean 3.36±1.06 mmol/L, abnormal rate of 27.87%.2 Imaging2.161 cases of osteonecrosis patients after SARS. were accrued hip (114 hips), of which 8 cases of a single hip, both hips in 53 cases, involving the femoral condyle (including internal and external condyle) 1 case 2, involving the femur 1 case of 2 remote,1 case involving the tibial plateau 2,1 case involving 2 of talus, head of the humerus in 1 case involving one.2.2 Into the group of 114 femoral head necrosis by ARCO standard staging,7 years later, the image result isⅠb24 hips,Ⅰc2hips.Ⅱb3hips,Ⅱc63 hips,Ⅲb2 hips,Ⅲc16 hips,Ⅳstage 4 hips.7 years after the imaging overall stability rate is 75.41%, including stability of the rate of I of patients accounted for 69.23%,Ⅱof stable rates accounted for 87.88% of patients.2.3Multiple channels of Chinese medicine treatment group (45 cases) and oral medicine symptomatic treatment group (16 cases) groups, two groups of imaging steady rate is 56.25% and 82.22%, two groups’imaging stable rate were significantly different, P<0.05.2.4The stability of imaging was associated with the amount of estrogen and progestin(P=:0.027<0.05), the correlation coefficient was 2.264. And body mass index, hormone use of total application time hormone, hormone daily dose, maximum dose of hormone were no statistically significant correlation (P>0.05).2.5The imaging stability was no significant correlation with the total use of hormone, there was no significant difference (P=0.242>0.05).2.6 The relationship between the hormone use and osteonecrosis of the total size (ARCO stageⅠ,Ⅱand so on) of was significant difference (P=0.021<0.05).2.7 The relationship between ARCO staging area and hormonic autacoid was significantly statistical difference (P=0.03<0.05).3 TCM syndrome ruleSARS patients with osteonecrosis,7 years later, according to the symptoms and syndrome type tongue and pulse are mainly phlegm and blood stasis obstruction syndrome and deficiency of the liver and kidney type.4 Harris score and SF-36 Quality of Life Scale4.1 The Harris score maximum is 100, minimum is 17.70 points,69.35⒈20.13 points. acceptance rate of Harris score is 39.34%, excellent rate is 14.75%. Pain in the hip joint, hip joint range of motion and function are poor.4.2 The quality of life’s mean scores is lower, indicating SARS patients with osteonecrosis is poor quality of life.4.3 Multiple channels of Chinese medicine treatment group (46 cases) and oral medicine symptomatic treatment group (15 cases) groups, comparison between two groups of Harris and quality of life is no significant statistical difference, P> 0.05. 4.4 Harris scale of pain, range of motion, joint function are correlate significantly with SF-36 scale of physical function, physical function, bodily pain, general health, energy, social function, emotional function, mental health (P<0.05), and joint deformities had no significant effect on quality of life (P> 0.05).Conclusion1 The amount of steroid hormones is correlated significantly on the progression of osteonecrosis, the use of hormone significantly affected the total size of the area and stage of osteonecrosis.2 The multiple channels of Chinese medicine treat osteonecrosis of femoral head is superior to oral medicine symptomatic treatment etc in the image stabilization rate.3 TCM syndrome are mainly phlegm and blood stasis obstruction syndrome and deficiency of the liver and kidney type, and Compared with phlegm obstruction syndrome and Blockage of the meridians, deficiency of the liver and kidney type reflects osteonecrosis’macronosia syndrome features.4 Pain, range of motion and joint function impact on quality of life of patients greater, it’s suggest the combination of function and quality of life evaluation method is more suitable for this type of chronic diseases as osteonecrosis of femoral head.