中药内服加熏洗在膝骨性关节炎关节镜清理术后的应用

Applied Traditional Chinese Medicine Oral Administration and Fumigation in Knee Osteoathritis after Arthroscopy

目的:探讨中药内服加熏洗对膝骨性关节炎(KOA)关节镜微创手术后的疗效及对关节液中肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)的影响。方法:将90例KOA患者随机按住院前后分为观察组和对照组各45例。两组均采用关节镜清理术,对照组术后采用西医常规处理。观察组术后即采用中药内服,1剂/d,共4周;中药熏洗,于术后第5天开始,2次/d,共14 d。观察Lysholm膝关节功能评分及症状、体征评分,监测术后第1,3,7,10,14天患者疼痛、肿胀及关节活动度,检测治疗后关节液中TNF-α和IL-1β水平。结果:治疗后观察组疗效优于对照组(P<0.01);治疗后第3天两组疼痛、肿胀、关节活动度均较术前明显改善(P<0.01);治疗后第7,10,14天观察组疼痛、肿胀、关节活动度改善程度优于对照组(P<0.01);治疗后观察组Lysholm评分明显上升,并高于对照组(P<0.01),观察组症状、体征评分均明显下降,并低于对照组(P<0.01);观察组关节液中TNF-α和IL-1β水平低于对照组(P<0.01)。结论:KOA关节镜清理术后采用中药内服及熏洗能改善患者疼痛、肿胀及关节活动度,促进关节功能恢复,提高临床疗效,其作用机制可能与下调关节液中TNF-α和IL-1β水平有关,值得进一步研究。

Objective： To observe the curative effect of traditional Chinese medicine oral administration and fumigation on knee osteoathritis after arthroscopy and the influence on tumor necrosis factor α（TNF-α） and interleukin-1β （IL-1β） of synovial fluid. Method： Ninety patients were randomly divided into observation group （n=45） and control group （n=45）. Both groups were given arthroscopy. Control group were given conventional western medicine treatment. Observation group were given traditional Chinese medicine oral administration, 1 dose each day, for 4 weeks. Traditional Chinese medicine fumigation was added in 5th days of postoperation, 2 times each day, for 14 days. Lysholm Knee function score and total symptom score were observed. patients with painful, swelling and joint mobility were in 1,3,7,10,14 day after treatment. The level of TNF-α, IL-1β of synovial fluid were tested. Result： The curative effect of observation group was superior to control group（P〈0.01）;patients with painful, swelling and joint mobility of both groups in 3 day were significantly improved than before（P〈0.01）;the degree of improvement of pain, swell and After the treatment of 7, 10, 14 days joint mobility of observation group was preceded than control group （P〈0.01）;the lysholm scores of observation group were obviously rison after treatment and higher than control group（P〈0.01）;total symptom scores of observation group were dramatic declined and lower than control group（P〈0.01）;the level of TNF-α, IL-1β of synovial fluid of observation group were lower than control group（P〈0.01）. Conclusion： Traditional Chinese medicine oral administration and fumigation on knee osteoathritis after arthroscopy could improve patients with painful, swelling and joint mobility, promote functional recovery of joint function, enhance clinical effects. The mechanism of action may be related with the level of TNF-α and IL-1β of synovial fluid and is deserved further study.