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[糖皮质激素性股骨头坏死的预防:一项长期临床随访研究]

[Prevention for glucocorticoid-induced osteonecrosis of femoral head: a long-term clinical follow-up trail].

作者信息

Liu B Y, Yang L, Wang B J, Wang Z H, Cheng L L, Xie H, Qiu X, Ma Z J, Zhao D W

机构信息

Department of Orthopedic, Zhongshan Hospital of Dalian University, Dalian 116001, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2017 Nov 7;97(41):3213-3218. doi: 10.3760/cma.j.issn.0376-2491.2017.41.004.

Abstract

To evaluated the outcome of prevention and treatment for glucocorticoid-induced osteonecrosis of femoral head with anticoagulant and vasodilator drugs. A prospective, randomized, double-blind study was performed. From August 2003 to August 2006, 58 patients with large amounts of hormone therapy in the Zhongshan Hospital Affiliated Dalian University were enrolled and randomly assigned to the control group (placebo) or preventive group (anticoagulant and vasodilator drugs). And we prospectively analyzed the clinical outcomes of 24 patients with glucocorticoid-induced osteonecrosis of femoral head early stage (treatment group)treated by anticoagulant and vasodilator drugsat the same time. Disease incidence rate and progression were evaluated by radiography and magnetic resonance imaging (MRI), Follow-up of patients with femoral head survival curve was drawn. The Harris Hip Score and the Short Form 36 health survey were used to rate hip function and quality of life, respectively. Thus, a total of 80 patients were assessed in this study, 24 cases in control group[follow up from 7.5 to 13.0(10.7±1.6)years], 22 cases in preventive group and 24 cases in treatment group. There was significant difference in theincidence rate of Osteonecrosis of femoral head, survive rate of femoral head and HHS score between the control groupand preventive group(41.7% vs 13.6%, 66.7% vs 70.8% , <0.01). Anticoagulant and vasodilator drugs could effect on preventing theglucocorticoid-induced osteonecrosis of femoral head, reducing disease progression, or improving life quality.

摘要

评估抗凝和血管扩张药物对糖皮质激素性股骨头坏死的防治效果。进行了一项前瞻性、随机、双盲研究。2003年8月至2006年8月,大连大学附属中山医院58例接受大量激素治疗的患者被纳入研究,并随机分为对照组(安慰剂)或预防组(抗凝和血管扩张药物)。同时,我们前瞻性分析了24例早期糖皮质激素性股骨头坏死患者(治疗组)接受抗凝和血管扩张药物治疗的临床结果。通过X线摄影和磁共振成像(MRI)评估疾病发病率和进展情况,绘制股骨头存活曲线对患者进行随访。采用Harris髋关节评分和简明健康调查问卷分别评估髋关节功能和生活质量。本研究共评估80例患者,对照组24例[随访7.5至13.0(10.7±1.6)年],预防组22例,治疗组24例。对照组和预防组在股骨头坏死发病率、股骨头存活率和HHS评分方面存在显著差异(41.7%对13.6%,66.7%对70.8%,P<0.01)。抗凝和血管扩张药物可有效预防糖皮质激素性股骨头坏死,减少疾病进展,或改善生活质量。

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