Clinical Efficacy Analysis On Treatment Of Systemic Lupus Erythematosus With Avascular Necrosis Of The Femoral Head By Huangqi Jisheng Decoction Combined With Total Hip Arthroplasty

Objective:Systemic Lupus Erythematosus(SLE)is an autoimmune disease and glucocorticoids(GCs)is essential for the treatment of the disease,but long-term application of GCs can lead to many adverse reactions.Avascular necrosis of the femoral head(AVNFH)is one of the common complications in patients with SLE.Total hip replacement(THA)is the main method for the treatment of end-stage hip diseases,especially stage Ⅳ of AVNFH.For SLE patients with AVNFH,GCs using history and osteoporosis are often present,THA is a high risk and perioperative management is more difficult,there is no unified surgical guidelines for such patients.The purpose of this study was to investigate the clinical effect of Huangqi Jisheng decoction combined with THA in the treatment of SLE-AVNFH patients with THA and Huangqi Jisheng decoction.Methods:From Sep.2016 to Jan.2019,20 patients(36 hips)with SLE complicated with AVNFH were treated with THA in Department of Orthopaedics,second affiliated Hospital of Shandong University of Traditional Chinese Medicine,including 4 males and 16 females,all of whom were followed up.AVNFH was stageⅣ,all 36 hips were treated with biological prosthesis,and were randomly divided into two groups:group A and group B.Routine treatment was performed before and after operation.Group A patients began to take Huangqi Jisheng decoction one week before operation,add or subtract the prescription after operation,take orally for 2 courses(one course is 30 days),B group patients do not take it.The WOMAC osteoarthritis index,VAS score,HHS score and(SLEDAI)score of SLE were compared before and after treatment in group A and B.to analyze the clinical effect of Huangqi Jisheng decoction combined with THA in the treatment of SLE with AVNFH.Results:①All the 20 patients(36 hips)were followed up.The(SLEDAI)score of all 20 patients before operation was less than 5,and the SLE was still.There was no significant difference between the two groups(P>0.05),and the mean operation time was not significant(P>0.05).There was no significant difference between the two groups(P>0.05)in the mean amount of blood loss and the mean follow-up time(P>0.05),and the two groups were comparable.②During the follow-up period,none of the patients had complications such as blade infection,nonunion,loosening of prosthesis,dislocation and periprosthetic fractures.③The operation improve the quality of life of patients greatly.The Vas score,HHS score and WOMAC score of the two groups were significantly improved compared with those before operation(P<0.05).The scores in group A were better than those in group B one week after operation(P<0.05),but there was no significant difference between the two groups at the last follow-up(P>0.05).The SLEDAI score of group A did not fluctuate significantly at the first week and the last follow-up after operation.The SLEDAI score of group B was significantly fluctuated compared with that of the first week after operation,but there was no significant fluctuation between the last follow-up and pre-operation.Conclusion:Huangqi Jisheng decoction combined with THA can significantly improve the quality of life of patients with SLE-AVNFH,alleviate the pain,reduce the fluctuation of lupus activity during the perioperative period,reduce the risk of postoperative complications,and the early and mid-term curative effect is safe and reliable.