【目的】 探究桑枝生姜汤（由生姜、桑枝、桂枝、透骨草、鹿角胶等中药组成）热敷对股骨头坏死患者疼痛程度缓解、 血液流变学恢复的疗效机制。【方法】 将2022年5月至2024年5月在中国中医科学院广安门医院保定医院就诊的104例股骨头 坏死患者按随机数字表法随机分为对照组和治疗组，每组各52例。对照组给予阿仑膦酸钠治疗，治疗组在对照组基础上加 用桑枝生姜汤热敷治疗，疗程为3个月。观察2组患者治疗前后中医证候积分、关节功能Harris评分、疼痛程度视觉模拟量 表（VAS）评分、血液流变学指标、骨代谢指标、股骨近端和腰椎松质骨骨密度水平的变化情况，并评价 2组患者的临床疗 效。【结果】（1）疗效方面，治疗 3 个月后，治疗组的总有效率为 92.31%（48/52），对照组为 71.15%（37/52），组间比较（χ2检 验），治疗组的疗效明显优于对照组（P < 0.01）。（2）中医证候积分方面，治疗后，2组患者的腰膝酸软、跛行、心烦失眠、下 肢酸困等中医证候积分均较治疗前下降（P < 0.05），且治疗组的下降幅度均明显优于对照组（P < 0.01）。（3）关节功能和疼痛程 度改善方面，治疗后，2组患者的关节功能 Harris评分均较治疗前升高（P < 0.05），疼痛程度 VAS评分均较治疗前下降（P < 0.05），且治疗组关节功能Harris评分的升高幅度和疼痛程度VAS评分的下降幅度均明显优于对照组（P < 0.01）。（4）血液流变 学指标方面，治疗后，2组患者的红细胞沉降率（ESR）、全血低切黏度（LBV）、全血高切黏度（HBV）等各项血液流变学指标 均较治疗前改善（P < 0.05），且治疗组的改善幅度均明显优于对照组（P < 0.01）。（5）骨代谢指标方面，治疗后，2组患者的血 清N-端骨钙素（N-MID）、Ⅰ型胶原羧基端肽β特殊序列（β-CTX）、总Ⅰ型胶原氨基端延长肽（T-PINP）水平均较治疗前下降 （P < 0.05），血清25-羟基维生素D[25-（OH）D]水平均较治疗前升高（P < 0.05），且治疗组血清N-MID、β-CTX、T-PINP水平 的下降幅度和血清25-（OH）D水平的升高幅度均明显优于对照组（P < 0.01）。（6）骨密度方面，治疗后，2组患者的股骨近端和 腰椎松质骨骨密度水平均较治疗前升高（P < 0.05），且治疗组的升高幅度均明显优于对照组（P < 0.01）。【结论】 对股骨头坏死 患者采用桑枝生姜汤热敷治疗，能有效降低中医证候积分，缓解疼痛感，改善关节功能，调节骨代谢及骨密度，恢复血液 流变学，临床治疗效果显著。

Objective To explore the therapeutic mechanism of hot compress with Sangzhi Shengjiang Decoction （manily composed of Zingiberis Rhizoma Recens，Mori Ramulus，Cinnamomi Ramulus，Speranskiae Tuberculatae Herba， and Cervi Cornus Colla）in relieving pain and improving hemorheology of patients with femoral head necrosis（FHN）. Methods A total of 104 patients with FHN who admitted to Guang􀆳anmen Hospital Baoding, China Academy of Chinese Medical Sciences from May 2022 to May 2024 were randomly divided into the control group and the treatment group according to the random number table method，with 52 cases in each group. The control group was treated with Alendronate Sodium orally，and the treatment group was given hot compress with Sangzhi Shengjiang Decoction on the basis of treatment for the control group. The course of treatment for the two groups covered three months. Before and after the treatment，the traditional Chinese medicine（TCM）syndrome score， Harris score of joint function， Visual Analogue Scale（VAS）score for pain， and the levels of hemorheology indicators，bone metabolism indicators，and bone mineral density（BMD）of proximal femur and lumbar trabecular bone in the two groups were observed. After treatment， the clinical efficacy of patients in the two groups was evaluated. Results（1）After three months of treatment，the total effective rate of the treatment group was 92.31% （48/52）and that of the control group was 71.15%（37/52），and the intergroup comparison（tested by chi-square test）showed that the clinical efficacy of the treatment group was significantly superior to that of the control group （P < 0.01）.（2）After treatment，the scores of TCM symptoms such as soreness and weakness in the waist and knee，claudication，restlessness and insomnia，and soreness and heaviness of lower limbs in the two groups were decreased compared with those before treatment（P < 0.05）， and the decreases in the treatment group were significantly superior to that in the control group（P < 0.01）.（3）After treatment，the Harris scores of joint function in the two groups were increased（P < 0.05）and the VAS scores for pain were decreased compared with those before treatment（P < 0.05），and the increase of Harris scores and the decrease of VAS scores in the treatment group were significantly superior to those in the control group（P < 0.01）.（4）After treatment， the levels of hemorheology indicators such as erythrocyte sedimentation rate（ESR），whole blood low-shear viscosity（LBV）， and whole blood high-shear viscosity （HBV） in the two groups were improved compared with those before treatment（P < 0.05），and the improvement in the treatment group was significantly superior to that in the control group（P < 0.01）.（5）After treatment，the levels of bone metabolism indicators such as serum N-terminal midfragment of osteocalcin（N-MID）β-C-terminal telopeptide of type I collagen（β-CTX）and total procollagen type I N-terminal propeptide（T-PINP）levels of patients in the two groups were decreased compared with those before treatment（P < 0.05），and serum 25-hydroxy vitamin D [25 -（OH）D] level was increased compared with that before treatment（P < 0.05）. The decrease of serum N-MID，β-CTX and T-PINP levels and the increase of serum 25-（OH）D level in the treatment group were significantly superior to those in the control group（P < 0.01）.（6） After treatment，BMD of proximal femur and lumbar trabecular bone in the two groups was increased compared with that before treatment（P < 0.05），and the increase in the treatment group was significantly superior to that in the control group（P < 0.01）. Conclusion Hot compress with Sangzhi Shengjiang Decoction exerts certain efficacy for the treatment of patients with FHN. The therapy is effective on reducing the scores of TCM syndrome，relieving pain， improving joint function， regulating bone metabolism and bone density， improving hemorheology indicators，and presenting remarkable therapeutic effect.

R274.9

国家自然科学基金项目（编号：81873322）