超声引导下针刀松解不同肌群治疗早中期股骨头缺血性坏死的临床疗效观察

Clinical Observation on the Therapeutic Effect of Ultrasound-Guided Needle-Knife Release of Different Muscle Groups for the Treatment of Early and Middle-Stage Avascular Necrosis of the Femoral Head

摘要: 目的：探讨松解不同肌群对股骨头缺血性坏死的活动度及症状改善差异，为临床治疗提供有力的理论依据。方法：选取2021年1月至2022年12月期间黑龙江中医药大学附属第二医院治疗的Charnley A型早中期股骨头缺血性坏死患者64例，按随机数字表法分为A组和B组，A组32例，B组32例。两组均在超声引导下进行，A组采用针刀松解内收肌群的方法治疗，B组采用针刀松解外旋肌群的方法治疗，共治疗30天。每2周测定两组治疗前和治疗后的Jaglal下肢测量评分(LEM)、视觉模拟定级(VAS)、Harris评分、髋活动度评分。结果：治疗前两组Jaglal下肢测量评分(LEM)、视觉模拟定级(VAS)、Harris评分、髋活动度评分比较，差异无统计学意义，具有可比性(P > 0.05)，治疗后两组Jaglal下肢测量评分(LEM)比较，差异无统计学意义(P > 0.05)。视觉模拟定级(VAS)评分比较，A组优于B组(P < 0.05)。Harris评分、髋活动度评分比较，B组优于A组(P < 0.05)。结论：A、B两组在髋关节活动度评分、Harris评分、LEM和VAS疼痛评分比较，在改善疼痛方面，A组优于B组。在改善髋关节活动度方面，B组优于A组，均各有优点，值得临床推广并应用。

Abstract: Objective: To explore the differences in activity and symptom improvement of avascular necrosis of the femoral head by relaxing different muscle groups and provide a strong theoretical basis for clinical treatment. Method: Sixty-four patients with Charnley type A early to middle-stage avascular necrosis of the femoral head treated at the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine from January 2021 to December 2022 were selected and randomly divided into Group A and Group B using a random number table. Group A had 32 patients, while Group B had 32 patients. Both groups were treated under ultrasound guidance. Group A was treated with needle-knife release of the adductor muscle group, while Group B was treated with needle-knife release of the external rotator muscle group for a total of 30 days. Every two weeks, the Jaglar Lower Limb Measurement Score (LEM), Visual Analog Scale (VAS), Harris Score, and Hip Movement Score were measured before and after treatment in two groups. Result: Before treatment, there was no statistically significant difference in the Jaglar Lower Limb Measurement Score (LEM), Visual Analog Scale (VAS), Harris Score, and Hip Movement Score between the two groups, indicating comparability (P > 0.05). After treatment, there was no statistically significant difference in the Jaglar Lower Limb Measurement Score (LEM) between the two groups (P > 0.05). Comparison of Visual Analog Scale (VAS) scores showed that Group A outperformed Group B (P < 0.05). Comparison of the Harris score and hip movement score showed that Group B was superior to Group A (P < 0.05). Conclusion: Comparing the hip movement score, Harris score, LEM and VAS pain score between Group A and Group B, Group A is superior to Group B in improving pain. In terms of improving hip movement, Group B is superior to Group A, each with its own advantages, and is worthy of clinical promotion and application.