通痹外敷膏联合关节腔冲洗治疗膝骨性关节炎合并积液的临床研究

Clinical study on the treatment of osteoarthritis of the knee with Tongbi topical ointment combined with articular cavity effusion flushing

目的观察中药通痹外敷膏联合关节腔冲洗术治疗膝骨性关节炎合并关节积液的疗效。方法收集2009年5月至2013年3月湖北医药学院附属太和医院针灸科膝关节骨性关节炎伴关节积液患者366例，采用随机数字表法将患者分为两组各183例，对照组采用口服盐酸氨基葡萄糖胶囊及关节腔冲洗术治疗，治疗组在对照组治疗基础上外敷通痹外敷膏治疗。分别于治疗前后测定关节炎积液中白细胞介素-1β（IL-1β）、透明质酸（HA）含量；采用视觉模拟评分量表（VAS）及加拿大西安大略和麦克玛斯特大学膝关节骨关节炎指数（WOMAC）评价临床疗效。结果治疗前及治疗后4周，治疗组IL-1β[分别为（39．29±7．52）p酌nl、（28．33±5．42）pg／m1]明显降低；HA含量[分别为（1．41±0．23）μg/L、（3．34±0．48）μg/L]明显升高；VAS评分[治疗前及后第1～4周分别为（7．21±0．35）分、（5．47±0．34）分、（5．04±0．32）分、（4．03±O．24）分、（2．23±0．15）分]逐步降低；WOMAC指数[治疗前及后第1～4周分别为（56．17±7-31）分、（46．32±6．34）分、（37．17±5.31）分、（29．04±3．58）分、（15．21±2．37）分]明显好转，与对照组治疗后第3、4周比较差异均有统计学意义（P〈0．05）。治疗组总有效率为98．9％（181／183）、对照组为87．4％（160／183），两组比较，差异有统计学意义（X^2=5．671，P〈0．01）。结论通痹外敷膏联合关节腔冲洗可有效治疗膝骨性关节炎合并积液。

Objective To observe the curative effect of traditional Chinese medicine on the treatment of osteoarthritis of the knee with Tongbi topical ointment combined with joint cavity effusion flushing. Methods 366 patients of osteoarthritis of knee joint with effusion were collected from May 2009 to March 2013 in Hubei University of Medicine Affiliated Taihe Hospital, and randomly recruited into a control group and a treatment group by random number table method, with 188 patients in each group. The control group was treated with the joint cavity drainage and oral taking glucosamine hydrochloride capsules, the treatment group was treated with external application of Tongbi ointment based on the control group. Leukocyte osteoarthritis -1 beta （IL-1 β） and hyaluronic acid （HA） were measured before and after the treatment. VAS and WOMAC osteoarthritis index were used to evaluate the effect. Results Compared with indexes before the treatment, IL-113[ （39.29±7.52）μg/ml, （28.33 ± 5.42） μg/ml] decreased significantly, HA content [ （1.41 ± 0.23）μg/L, （3.34± 0.48） μg/L] increased significantly, VAS score [before treatment and 1-4weeks were （7.21±0.35）, （5.47±0.34）, （5.04±0.32）, （4.034±0.24）, （2.23±0.15）] decreased and the WOMAC index[（56.17±7.31）, （46.32±6.34）, （37.17± 5.31）, （29.04±3.58）, （15.21±2.37） ] improved significantly in the treatment group after 4 weeks of treatment There was a significant difference between the treatment and the control group showed （P〈0.05）. Combined with the total effective rate of 98.9% （ 181 /183 ） in treatment group, the control group of 87.4% （ 160/183 ） showed a significant difference （P〈0.01）. Conclusion External application of Tongbi ointment combined with joint cavity flushing was effective in the treatment of osteoarthritis of the knee with effusion.