针刀方案结合中药内服外敷法治疗类风湿关节炎顽固性肿痛的临床研究

Clinical Study of Needle- Knife Therapy Combined with Internal and External TCM in Treating Refractory Sore of Rheumatoid Arthritis

目的:探讨针刀联合中药内服外敷对类风湿关节炎(RA)顽固性肿痛患者的临床应用价值。方法:选取135例伴顽固性肿痛的类风湿关节炎患者为研究对象,根据其治疗时间分成针刀组(A组,n=45)、联合组(B组,n=45)和对照组(C组,n=45)3组。C组患者予以常规治疗方案,A组予以针刀+常规治疗方案,B组患者在上述基础上联合中药内服外敷疗法。行为期6个月随访,比对3组患者临床疗效差异,记录其治疗前后中医症状评分改善情况,分析其晨僵时间、消肿时间、止痛时间、疼痛评分、睡眠质量评分等指标差异,记录其治疗前后关节肿胀数量/指数、关节疼痛数量/指数、关节压痛数量/指数等治疗指标变化情况。结果 :(1)C组治疗总有效率为62.2%,显著低于A组的80.0%,B组治疗总有效率为3组最高,达到95.6%,对比差异具有统计学意义(P<0.05);(2)治疗后,3组患者中医症状评分及关节肿胀、疼痛、压痛的数量、指数等指标均较治疗前显著降低,其中B组降幅>A组>C组,差异具有统计学意义(P<0.05);(3)B组患者晨僵时间、消肿时间、止痛时间、疼痛评分、睡眠质量评分等治疗指标均显著低于A、C两组(P<0.05);A组各治疗指标显著低于C组患者(P<0.05)。结论:对伴有顽固性肿痛的类风湿关节炎患者予以针刀联合中药内服外敷疗法,临床疗效确切,可有效缓解其晨僵、关节疼痛、关节肿胀及压痛症状,对促进患者病情转归、提高其预后质量具有积极影响,值得临床推广。

Objective： To explore the clinical application value of needle- knife therapy combined with internal and external TCM（ traditional Chinese medicine） in treating patients with refractory sore of rheumatoid arthritis（ RA）. Methods： 135 patients with rheumatoid arthritis（ RA） complicated by intractable sore were selected as the research object and according to the treatment time were divided into the needle- knife group（ group A,n = 45）,the combined group（ group B,n = 45） and the control group（ group C,n = 45）. Group C were given routine therapy; group A were given needle-knife combined with conventional treatment and patients in group B,on the basis of the above treatment,were given combined internal and external TCM therapy. With 6 months of follow- up in behavior phase,the clinical efficacy was compared among the three groups. The improvement satus of TCM symptom scores before and after the treatment was recorded. The index differences in time of morning stiffness,detumescence and analgesia and scores of pain,sleep quality and other indexes were analyzed. The changes of number of swelling of joint / index,of arthralgia / index,of tenderness / index and other treatment indexes before and after the treatment were recorded. Results：（1）The total efficiency of group C was62. 2%,which was significantly lower than 80. 0% of group A while the total efficiency of group B was the highest,reaching 95. 6% and the differences were statistically significant（ P〈0. 05）.（2）After the treatment,TCM symptom scores,swelling of joint,pain,number of tenderness and other indexes among the three groups significantly reduced,compared with those before the treatment and the decline of group B was the greatest,followed by group A and group C and the differences were statistically significant（ P〈0. 05）.（3）In group B,the time of morning stiffness,detumescence and anal-gesia,scores of pain and sleep quality and other treatment indexes were significantly lower than those in A and C groups（ P〈0. 05）. In group A,the treatment indexes were significantly lower than those in group C（ P〈0. 05）. Conclusion： To adopt needle- knife therapy combined with internal and external TCM for treating patients with rheumatoid arthritis accompanied by intractable pain,the clinical curative effect is definite,which can effectively alleviate morning stiffness,joint pain,joint swelling and tenderness symptoms and has a positive impact on promoting the patients outcomes and improving quality of prognosis of patients. It is worthy of clinical promotion.