中西医结合治疗退行性膝关节炎的前瞻性队列研究

Prospective cohort study on rehabilitation therapy of knee degenerative osteoarthritis with integrated Chinese traditional and western medicine

目的探讨针灸、推拿、中药内服配合西药玻璃酸钠关节腔注射治疗退行性膝关节炎(knee degenerative osteoar-thritis,KOA)的临床疗效。方法纳入90例KOA患者,分为试验组和对照组各45例。试验组给予针灸、推拿、中药汤剂内服,配合玻璃酸钠关节腔注射治疗;对照组采用中频、超短波、特定电磁波谱(TDP)治疗,配合口服盐酸氨基葡萄糖胶囊和玻璃酸钠关节腔注射。1个总疗程(35d)后对两组的疗效及治疗前后膝关节功能评分进行统计分析。结果试验组与对照组的临床总有效率分别为91.11%和55.56%,差异有统计学意义(P<0.01);治疗后两组膝关节疼痛、压痛、肿胀、晨僵、行走能力分值比较差异均有统计学意义(P<0.01)。结论针灸、推拿、中药汤剂内服配合玻璃酸钠关节腔注射治疗KOA较中频、超短波、TDP治疗配合口服盐酸氨基葡萄糖胶囊具有明显的疗效与优势,值得进一步探索和研究。

Objective To explore the clinical efficiency of acupuncture, manipulation, Chinese herbs combined with sodium hyaluronate injection on the treatment of knee degenerative osteoarthritis（KOA）. Methods Ninety patients diagnosed as KOA in our hospital during the period from January 2010 to January 2012 were divided into experimental group and control group,45 in each group. In the experimental group, patients were treated with acupuncture, moxibustion, manipulation, and oral administration of TCM decoction plus articular cavity injection of sodium hyaluronate. In the control group, intermediate frequency, ultrashort wave, and special electro- magnetic therapeutic apparatus（TDP） were applied. Meanwhile, patients in the control group were oral administrated with glucosamine hydrochloride capsules and injected with sodium hyaiuronate as well. Treatment course was 35 days, and patients had 2 days break every 7 days of treatment. The clinical effects were statistically analyzed. Results Total effective rates were 91.11% for the experimental group and 55.56% for the control group, respectively. The difference was statistically significant（ P 〈 0. 01 ）. Scores of knee pain, tenderness, swelling, stiffness and walking ability were also significantly different between the two groups （ P〈 0.01 ）. Conclusions Clinical efficiency of the experimental regimen may be better than that of the control approach for knee degenerative osteoarthritis.