手法加熏洗与微创疗法治疗膝骨性关节炎的临床观察

Comparative Study on Effects of Combined Massage-Smouldering-Washing Therapy and Mini-invasive Surgery in Treating Knee Osteoarthritis

目的对手法加熏洗和微创疗法治疗轻、中度膝骨性关节炎(knee osteoarthritis,KOA)的疗效进行对比观察,为患者提供合适的综合治疗方案。方法60例KOA患者分为两组。治疗组采用手法加熏洗疗法,10天为1个疗程,每疗程间隔3天,共4个疗程;对照组采用微创关节镜下清理术加透明质酸钠注射疗法,术后每周膝关节腔内注射透明质酸钠注射液(20mg)1次,连续5次。观察两组疗效及治疗前后临床症状及体征评分变化。结果经3个月随访,治疗组患者有效率90.0%,对照组患者有效率93.3%;两组疗法都能有效改善患者临床症状及体征评分,治疗组在改善膝关节疼痛、膝部肿胀、腰膝酸软、膝关节怕冷4项指标优于对照组(P<0.05);对照组在改善膝关节半蹲和全蹲疼痛、上下楼疼痛、膝部僵硬、关节活动度4项指标方面优于治疗组(P<0.05)。结论两种疗法均具有确切的疗效,侧重不同。

Objective To comparatively study the curative effects of combined massage-smouldering-washing therapy （MSW） and mini-invasive surgery in treating knee osteoarthritis （KOA） of mild-moderate degree so as to provide a suitable therapeutic protocol. Methods Sixty patients with KOA were assigned to two groups. The treatment group was treated with MSW once a day for 10 days as one course, and 4 courses were applied totally with an interval of 3 days between courses. The control group was treated with mini-invasive surgery by arthroscopic mopping, followed with post-operational intra-articular cavity injection with sodium hyaluronate injection, 20 mg every week for 5 times continuously. The therapeutic effect and the changes in scores of clinical symptoms and signs before and after treatment in the two groups were observed and compared. Results Outcome of 3-month follow-up showed the effective rate was 90% in the treatment group and 93.33% in the control group; scores of clinical symptoms and signs effectively improved in both groups, but the improvement on the 4 items （joint pain, swelling, soreness of loin and knee, and cold aversion of knee） was superior in the treatment group, while that on the other 4 items （pain during squatting or half-squatting, up stairs or down stairs, joint stiffiness and joint kinetic capacity） was superior in the control group （P 〈 0.05 ）. Conclusion Both MSW and mini-invasive surgery have definite curative effect on KOA but with different particularities.