中西医结合治疗膝关节骨关节炎的研究

Study on the treatment of knee osteoarthritis with combination of traditional Chinese and western medicine

目的观察中西医结合方法治疗膝关节骨关节炎(KOA)的疗效及对血清炎性细胞因子IL-1β、IL-6及肿瘤坏死因子-α(TNF-α)的影响。方法将120例KOA患者随机分为治疗组60例及对照组60例,对照组给予盐酸氨基葡萄糖口服,玻璃酸钠关节腔注射与运动锻炼治疗,治疗组在此基础上急性期给予针刀治疗,缓解期给予中药热熨治疗。观察2组治疗前后膝关节功能积分及血清白细胞介素IL-1β、IL-6及TNF-α的变化,并在6个月时随访复发情况。结果治疗3 d后,2组膝关节功能评分的大部分项目均明显改善(P<0.05或P<0.01),且治疗组改善情况优于对照组(P<0.05或P<0.01)。治疗3周后,2组膝关节功能评分与治疗前、治疗3 d后比较差异均有统计学意义(P均<0.01),且治疗组改善情况优于对照组(P<0.05或P<0.01)。2组治疗后血清IL-1β、IL-6与TNF-α水平均较治疗前显著下降(P<0.05或P<0.01),且治疗组下降程度优于对照组(P<0.05或P<0.01)。结论中西医结合治疗KOA疗效显著,改善关节功能,并可降低患者血清IL-1β、IL-6与TNF-α水平。

Objective It is to explore the therapeutical effect of therapy project combining traditional Chinese and western medicine on knee osteoarthritis （KOA） and on the correlated serum inflammatory factors indexes such as IL- 1β, IL-6 and TNF-α. Methods 120 patients with KOA were divided randomly into control group （n = 60 ）and treatment group （n = 60）. The patients in control group were treated with oral glucosamine hydrochloride, sodium hyaluronate intra-articular injection and exercises, while the ones in treatment group were treated with the therapy project of combining traditional Chinese and western medicine including small knife, exercise, sodium hyaluronate intra-articular injection and hot iron therapy of traditional Chi- nese medicine. The scores of Lysholm＇s knee joint function and the serum markers（ IL- 1β, IL- 6 and TNF-α）before and after treatment were observed. The recurrence was followed up after 6 months. Results After three days＇ treatment, the scores of most items of Lysholm＇ s knee joint function of the patients in two groups had significant differences compared with the ones before the treatment. The improvements of the indexes of the patients in treatment group were better than that in control group. After three weeks＇ treatment, the scores of knee joint function of the patients in two groups had significant differences com- pared with the ones before the treatment and the therapy for three days. There were significant differences between the levels of serum markers（ IL- 1β,IL-6 and TNF-α）of the patients in treatment group and the ones in control group. The recutwence of treatment group was lower than that of control group after the treatment for 6 months. Conclusion The therapy project combi- ning traditional Chinese and western medicine is very effective for KOA, which can improve the scores of Lysholm＇s knee joint function and reduce the scores of syndrome and signs and the levels of the serum markers（ IL- 1β ,IL- 6 and TNF-α）.