【目的】 探究桃红四物汤对股骨头坏死患者保髋术后关节肌力、骨密度恢复的疗效机制。【方法】 选取 2022年 4月～ 2024年4月中国中医科学院广安门医院保定医院收治的110例股骨头坏死患者，采用随机数字表法将患者随机分为对照组和 研究组，每组各55例。所有入组患者均行股骨头钻孔减压术治疗，对照组术后给予西医常规治疗，研究组在对照组的基础 上给予桃红四物汤加减治疗，疗程均为8周。观察2组患者治疗前后中医证候积分、疼痛程度视觉模拟量表（VAS）评分、关 节功能Harris评分、关节肌力、骨密度、血液流变学指标（包括血浆黏度、全血高切黏度、全血低切黏度）、骨代谢指标[包 括碱性磷酸酶（ALP）、骨钙素（BGP）、骨形态发生蛋白2（BMP-2）]的变化情况，并评估2组患者的临床疗效。【结果】（1）疗 效方面，治疗8周后，研究组的总有效率为92.73%（51/55），显著高于对照组的72.73%（40/55），组间比较，差异有统计学意 义（χ2 = 7.698，P＜0.01）。（2）中医证候方面，治疗后，2组患者的髋关节疼痛、腰膝酸软、神疲乏力、脉沉细涩积分均较治 疗前降低（P＜0.05），且研究组的降低幅度均明显优于对照组（P＜0.01）。（3）疼痛程度和关节功能方面，治疗后，2组患者的 疼痛程度VAS评分均较治疗前降低（P＜0.05），关节功能Harris评分均较治疗前升高（P＜0.05），且研究组对疼痛程度VAS评 分的降低幅度和对关节功能Harris评分的升高幅度均明显优于对照组（P＜0.01）。（4）血液流变学方面，治疗后，2组患者的血 浆黏度、全血高切黏度、全血低切黏度均较治疗前降低（P＜0.05），且研究组的降低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ALP水平均较治疗前降低（P＜0.05），血清BGP、BMP-2水平均较治疗前升高（P＜ 0.05），且研究组对血清ALP水平的降低幅度和对血清BGP、BMP-2水平的升高幅度均明显优于对照组（P＜0.01）。（6）关节肌 力方面，治疗后，研究组患者的关节肌力3级人数均较治疗前明显减少，4级人数均较治疗前明显增多，差异均有统计学意 义（P＜0.05）；而对照组的关节肌力虽有一定程度改善，但差异均无统计学意义（P＞0.05）；治疗后组间比较，研究组的关节 肌力3级人数较对照组明显减少，4级人数较对照组明显增多，差异均有统计学意义（P＜0.01）。（7）骨密度方面，治疗后，2组 患者的股骨头局部骨密度和平均骨密度均较治疗前升高（P＜0.05），且研究组的升高幅度均明显优于对照组（P＜0.01）。 【结论】 桃红四物汤应用于股骨头坏死保髋术后的治疗中，能有效降低中医证候积分，减轻疼痛程度，改善关节功能和血液 流变学状态，恢复骨密度和骨代谢情况，提高临床整体治疗效果。

Objective To explore the mechanism of Taohong Siwu Decoction in recovering joint muscle strength and bone mineral density（BMD） in patients after hip preservation surgery for osteonecrosis of the femoral head （ONFH）. Methods A total of 110 ONFH patients admitted to Guang’anmen Hospital Baoding Branch， China Academy of Chinese Medical Sciences from April 2022 to April 2024 were enrolled. The patients were equally randomized into a control group and a study group using a random number table，with 55 cases in each group. All patients underwent core decompression surgery and then were given postoperative conventional western medical treatment， and the study group received additional modified Taohong Siwu Decoction. The course of treatment lasted for 8 weeks. Before and after treatment，the two groups were observed in the changes of traditional Chinese medicine（TCM） syndrome scores，Visual Analogue Scale（VAS） score for pain，Harris hip score，joint muscle strength， bone mineral density（BMD）， hemorheological parameters（including plasma viscosity， whole blood high-shear viscosity，and whole blood low-shear viscosity），and bone metabolism markers [including alkaline phosphatase（ALP）， osteocalcin（BGP）， and bone morphogenetic protein 2（BMP-2）]. After treatment， the clinical efficacy was evaluated between groups. Results （1） After 8 weeks of treatment，the total effective rate in the study group was 92.73% （51/55），which was significantly higher than that in the control group （72.73%， 40/55）. The intergroup comparison showed a statistically significant difference （χ²＝7.698， P＜0.01）.（2） After treatment，scores for hip pain，soreness and weakness of the lower back and knees，mental fatigue，and deepthin-choppy pulse decreased in both groups compared with those before treatment （P＜0.05）. Moreover， the magnitude of reduction in all these scores was significantly greater in the study group than that in the control group （P＜0.01）.（3） After treatment，the VAS scores for pain severity decreased in both groups compared with baseline （P＜0.05）， while the Harris scores for joint function increased in both groups （P＜0.05）. Furthermore， the magnitude of reduction in VAS scores and the magnitude of improvement in Harris scores were both significantly greater in the study group than those in the control group （P＜0.01）.（4） After treatment，plasma viscosity，highshear whole blood viscosity，and low-shear whole blood viscosity decreased in both groups compared with those before treatment （P＜0.05）. Additionally， the reductions in all these parameters were significantly more pronounced in the study group than in the control group （P＜0.01）. （5） After treatment， serum alkaline phosphatase （ALP） levels decreased in both groups （P＜0.05）， while serum osteocalcin （BGP） and bone morphogenetic protein-2 （BMP-2） levels increased in both groups （P＜0.05）. Crucially， the magnitude of reduction in serum ALP levels and the magnitude of elevation in serum BGP and BMP-2 levels were all significantly greater in the study group than those in the control group （P＜0.01）.（6） After treatment， in the study group，the number of patients with Grade 3 muscle strength significantly decreased while the number with Grade 4 muscle strength significantly increased compared with those before treatment （P＜0.05）. In contrast， although the control group showed some improvement in joint muscle strength，the changes were not statistically significant （P＞0.05）. After treatment，the intergroup comparisons showed that the study group had a significantly smaller number of patients with Grade 3 muscle strength and a significantly larger number with Grade 4 muscle strength than the control group （P＜0.01）.（7） After treatment，both local femoral head BMD and average BMD increased in both groups compared with those before treatment （P＜0.05）. The magnitude of increase in both local and average BMD was significantly greater in the study group than that in the control group （P＜0.01）.Conclusion The application of Taohong Siwu Decoction in the treatment of in patients after hip preservation surgery for ONFH is effective on reducing TCM syndrome scores，alleviating pain，improving joint function and hemorheology，and restoring BMD and bone metabolism indicators，which enhances the overall clinical efficacy for the patients.

R274.9

国家自然科学基金资助项目 （编号：81873322）