活络散外敷联合祛瘀消痛汤内服治疗寒湿阻络型膝骨关节炎疗效分析

Clinical Efficacy of External Application of Huoluo PowderCombined with Quyu Xiaotong Decoction Orally in Treatment of Knee Osteoarthritis of Cold-Damp in Collaterals

目的:观察活络散外敷联合祛瘀消痛汤内服治疗寒湿阻络型膝骨关节炎的临床疗效。方法:选取89例膝骨关节炎患者随机分为对照组和观察组,对照组患者采用硫酸氨基葡萄糖胶囊联合塞来昔布胶囊治疗,观察组采用活络散外敷联合祛瘀消痛汤内服治疗,两组患者均6周为1个疗程,连续治疗2个疗程。比较两组患者治疗前后关节液中的软骨代谢因子水平、Lyshom评分、WOMAC评分、VAS评分、关节超声检查、中医证候积分、生存质量及临床疗效评价,并进行统计分析。结果:观察组患者治疗的总有效率为91.1%,对照组患者的临床总有效率为79.5%,两组比较差异有统计学意义(P<O.05)。治疗后两组患者关节液中的PG、COMP、BMP-7、MMP-3、MMP-9均较治疗前明显下降(P<0.05),TGF-β1较治疗前明显升高(P<0.05),并且观察组的变化幅度较对照组大(P<O.05);而TIMP-1治疗前后没有统计学意义(P>O.05);治疗后两组的软骨厚度与治疗前比较没有统计学意义(P>0.05);治疗后两组的滑膜厚度和关节积液均明显降低(P<O.05),并且观察组的滑膜厚度和关节积液低于对照组,两组比较有统计学意义(P<0.05)。两组的TIMP-1较治疗前变化不甚明显(P>0.05)。治疗6周、12周后Lyshom评分明显升高,WOMAC评分及VAS评分均明显降低(P<0.05),观察组的各项评分较对照组变化明显(P<O.05);观察组患者的中医症候积分及AIMS2-SF评分均显著低于对照组(P<0.05)。结论:活络散外敷联合祛瘀消痛汤内服治疗寒湿阻络型膝骨关节炎的疗效确切,并可以有效调节骨代谢指标,为临床用药提供有益参考。

Objective:To observe the clinical effect of the external application of Huoluo Powder combined with Quyu Xiaotong Decoction orally in the treatment of knee osteoarthritis of cold -damp in collaterals.Methods :Eighty -nine patients with knee osteoarthritis were randomly divided into the control group and the observation group.Patients in control group were treated with glucosamine sulfate capsule combined with celecoxib capsule.Patients in the observation group were treated with the external application of Huoluo Powder combined withQuyu Xiaotong Decoction orally.Patients of the two groups were treated for 2 consecutive courses,6 weeks for a course of treatment.The cartilage metabolic factor level, Lyshom score,WOMAC score,VAS score,joint ultrasound examination,TCM syndrome score,quality of life and clinical curative effect were compared between the two groups before and after treatment,and the statistical analysis was made.Results:The total effective rate was 91.1% in the observation group and 79.5% in the control group.The difference between the two groups was statistically significant(P <0.05).The levels of PG,COMP,BMP-7,MMP-3 and MMP-9 in the synovial fluid of the two groups after treatment were significantly lower than those before treatment(P < 0.05).The level of TGF-β1 of the two groups after treatment was significantly higher than that before treatment(P < 0.05),and the change range of the observation group was larger than that of the control group (P <0.05).However,there was no significant difference of TIMP -1 level before and after treatment (P >0.05).Compared with that before treatment there was no statistical difference in the cartilage thickness of the two groups after treatment (P >0.05).The synovial thickness and joint effusion of the two groups were significantly decreased after treatment (P <0.05),and the synovial thickness and joint effusion of the observation group were lower than of the control groupwith statistical significance (P <0.05).The change of TIMP -1 in the two groups was not obvious (P >0.05).Lyshom score increased significantly,WOMAC score and VAS score decreased significantly after 6 and 12 weeks of treatment(P <0.05).The score of the observation group changed significantly compared with that of the control group.TCM symptom score and AIMS2-SF score in observation group were significantly lower than those in the control group (P <O.05).Conclusion :The clinical effect of the external application of Huoluo Powder combined withQuyu Xiaotong Decoction orally in the treatment of knee osteoarthritis of cold-damp in collaterals is exact,which can effectively adjust bone metabolism indicators and provide a useful reference for clinical use.