【目的】 观察针刺环跳、委中穴联合高能体外冲击波（ESWT）治疗早期股骨头坏死（ONFH）对髋关节功能及炎症相关因 子表达的影响。【方法】 选取2021年2月至2023年12月西安工会医院病房及门诊收治的90例明确诊断为早期ONFH患者为研 究对象。按随机数字表将患者随机分为观察组和对照组，每组各45例。对照组给予体外冲击波（ESWT）治疗，观察组在对照 组治疗的基础上，给予针刺环跳、委中穴治疗，共治疗8周。治疗后，评价2组临床疗效。观察2组患者治疗前后中医证候 积分和疼痛视觉模拟量表（VAS）评分的变化情况，以及髋关节功能 Harris 评分和髋关节内-外旋转活动度（I-ER ROM）的情 况。比较2组患者治疗前后D-二聚体（D-D）、全血高切黏度（HRV）、全血低切黏度（LRV）、血浆黏度（PV）的水平以及肿瘤 坏死因子 α（TNF-α）、白细胞介素 1β（IL-1β）含量的变化情况。【结果】（1）观察组总有效率为 95.56%（43/45），对照组为 75.56%（34/45）。观察组疗效优于对照组，差异有统计学意义（P＜0.05）。（2）治疗后，2组患者的髋部隐痛、关节强硬、行走 乏力、腰膝酸软积分明显改善（P＜0.05），且观察组在改善髋部隐痛、关节强硬、行走乏力、腰膝酸软积分方面明显优于对 照组，差异有统计学意义（P＜0.05）。（3）治疗后，2 组患者的髋关节功能 Harris 评分、I-ER ROM、VAS 评分明显改善（P＜ 0.05），且观察组在改善髋关节功能Harris评分、I-ER ROM、VAS评分方面明显优于对照组，差异有统计学意义（P＜0.05）。 （4）治疗后，2组患者的血清TNF-α、IL-1β水平明显改善（P＜0.05），且观察组在改善血清TNF-α、IL-1β水平方面明显优于 对照组，差异有统计学意义（P＜0.05）。（5）治疗后，2组患者的血清D-D、HRV、LRV、PV水平明显改善（P＜0.05），且观察 组在改善血清D-D、HRV、LRV、PV水平方面明显优于对照组，差异有统计学意义（P＜0.05）。【结论】 针刺环跳、委中穴联 合高能ESWT治疗早期ONFH，能明显提高患者髋关节功能，改善血液流变学状态，缓解患者髋关节的疼痛症状，扩大髋关 节I-ER ROM，减轻炎症反应，降低血清TNF-α、IL-1β水平，疗效显著。

Objective To observe the effects of acupuncture at Huantiao（GB30） points and Weizhong（BL40） points combined with high-energy extracorporeal shock wave therapy（ESWT） on hip joint function and the expression of inflammation-related factors in patients with early-stage osteonecrosis of the femoral head （ONFH）. Methods A total of 90 patients diagnosed with early-stage ONFH and admitted to the wards and outpatient clinics of Xi’an Trade Union Hospital from February 2021 to December 2023 were selected as the study subjects. The patients were randomly divided into an observation group and a control group using a random number table，with 45 patients in each group. The control group received ESWT，while the observation group received acupuncture at Huantiao points and Weizhong points in addition to ESWT. The treatment lasted for 8 weeks. After treatment，the clinical efficacy of the two groups was evaluated. Changes in traditional Chinese medicine（TCM） syndrome scores， Visual Analogue Scale （VAS） scores for pain，Harris hip scores，and internal-external rotation range of motion （I-ER ROM） of the hip joint were observed before and after treatment. Changes in levels of D-dimer（D-D）， high-shear whole blood viscosity（HRV），low-shear whole blood viscosity（LRV），plasma viscosity （PV），tumor necrosis factor-α（TNF-α），and interleukin-1β（IL-1β） were compared between the two groups before and after treatment. Results （1） The total effective rate in the observation group was 95.56% （43/45），compared to 75.56% （34/45） in the control group. The observation group showed significantly better efficacy than the control group， with a statistically significant difference（P＜0.05）. （2）After treatment， both groups showed significant improvements（P＜0.05） in scores for hip dull pain，joint stiffness，walking fatigue，and soreness of the waist and knees，and the observation group was significantly superior to the control group in improving these scores， with a statistically significant difference（P＜0.05）. （3）After treatment， both groups showed significant improvements（P＜0.05） in Harris hip scores， I-ER ROM， and VAS scores， and the observation group was significantly superior to the control group in improving these scores，with a statistically significant difference （P＜ 0.05）.（4）After treatment，both groups showed significant improvements （P＜0.05） in serum TNF-α and IL-1β levels，and the observation group was significantly superior to the control group in improving these levels，with a statistically significant difference （P＜0.05）.（5） After treatment，both groups showed significant improvements （P＜0.05） in serum D-D，HRV，LRV，and PV levels，and the observation group was significantly superior to the control group in improving these levels， with a statistically significant difference（P＜0.05）. Conclusion Acupuncture at Huantiao points and Weizhong points combined with high-energy ESWT can significantly improve hip joint function， enhance hemorheological status， alleviate hip pain， increase I-ER ROM， reduce inflammatory responses， and lower serum TNF- α and IL-1β levels in patients with early-stage ONFH. The treatment shows significant efficacy.

R246.9

国家自然科学基金资助项目（编号：81873322）