铍针松解和针刀松解治疗早中期膝骨关节炎的短期临床疗效观察

Observation on the short- term clinical curative effect of release with stiletto needle versus knife needle for treatment of early- middle knee osteoarthritis

目的：观察铍针松解和针刀松解治疗早中期膝骨关节炎（knee osteoarthritis,KOA）的短期临床疗效。方法：将113例早中期KOA患者随机分为3组,铍针组38例、针刀组38例、扶他林组37例,分别给予铍针松解、针刀松解和扶他林乳胶剂涂抹膝关节疼痛部位,2周为1个疗程,共治疗1个疗程。比较治疗前后3组患者的膝关节软组织位移值、香蕉面积比值、压痛值、疼痛视觉模拟量表（visual analogue scale,VAS）评分及日本骨科学会（Japanese orthopaedic association,JOA）KOA疗效评分。结果：5例患者失访,其中铍针组2例、针刀组2例、扶他林组1例。108例患者完成治疗并获得随访,随访时间28-35 d,中位数30 d,均未出现不良反应。治疗前3组患者的膝关节软组织位移值、香蕉面积比值、压痛值、VAS评分及JOA评分比较,组间差异均无统计学意义[（5.61±0.50）mm,（5.80±0.65）mm,（5.67±0.68）mm,F=0.877,P=0.419;（72.01±3.23）%,（70.92±3.72）%,（71.48±5.87）%,F=0.546,P=0.581;（27.44±5.19）N,（27.24±7.64）N,（29.50±5.49）N,F=1.532,P=0.221;（4.65±0.71）分,（4.28±0.77）分,（4.36±0.85）分,F=2.283,P=0.107;（72.36±5.00）分,（71.67±3.96）分,（71.81±4.50）分,F=0.239,P=0.788]。治疗结束后1个月,3组患者的膝关节软组织位移值、香蕉面积比值、压痛值及VAS评分比较,组间差异均有统计学意义[（7.49±0.52）mm,（6.69±0.68）mm,（6.52±0.74）mm,F=32.280,P=0.000;（58.95±4.50）%,（61.66±4.02）%,（64.24±6.52）%,F=14.095,P=0.001;（46.06±6.76）N,（36.55±8.13）N,（36.46±6.17）N,F=31.015,P=0.000;（0.76±0.62）分,（2.06±0.76）分,（2.64±0.71）分,F=58.117,P=0.000];JOA评分比较,组间差异无统计学意义[（89.72±8.10）分,（87.50±6.27）分,（85.69±7.67）分,F=3.965,P=0.138]。治疗结束后1个月,3组患者的软组织位移值均较治疗前升高（t=-18.395,P=0.000;t=-16.693,P=0.000;t=-11.684,P=0.000）,铍针组的软组织位移值高于针刀组和扶他林组（P=0.000;P=0.000）,针刀组与扶他林组比较差异无统计学意义（P=0.153）;3组患者的香蕉面积比值均较治疗前降低（t=23.148,P=0.000;t=21.909,P=0.000;t=-13.081,P=0.000）,铍针组的香蕉面积比值低于扶他林组（P=0.001）,铍针组与针刀组比较差异无统计学意义（P=0.075）,针刀组与扶他林组比较差异无统计学意义（P=0.412）;3组患者的压痛值均较治疗前升高（t=-21.091,P=0.000;t=-11.338,P=0.000;t=-10.917,P=0.000）,铍针组的压痛值高于针刀组和扶他林组（P=0.000;P=0.001）,针刀组与扶他林组比较差异无统计学意义（P=0.848）;3组患者的VAS评分均较治疗前降低（t=30.138,P=0.000;t=21.622,P=0.000;t=12.552,P=0.000）,铍针组的VAS评分低于针刀组和扶他林组（P=0.000;P=0.000）,针刀组的VAS评分低于扶他林组（P=0.012）。结论：铍针松解、针刀松解及扶他林乳胶剂外用治疗早中期KOA的短期临床综合疗效相当,但铍针松解能更好地缓解膝关节疼痛,值得临床推广应用。

Objective：To observe the short-term clinical curative effects of release with stiletto needle versus knife needle for treat-ment of early-middle knee osteoarthritis（KOA）.Methods：One hundred and thirteen patients with early-middle KOA enrolled in the study were randomly divided into stiletto needle group（38 cases）,knife needle group（38 cases）and voltaren group（37 cases）,and were treated with stiletto needle release,knife needle release and votalin emulgel applied to the knee pain sites respectively for one course of treatment,2 weeks for each course.The displacement values,banana area ratio,tenderness values and pain visual analogue scale（VAS） scores of knee-joint soft tissue and Japanese orthopaedic association（JOA）scores for curative effect evaluation of KOA were compared be-tween the 3 groups before and after the treatment and between pretreatment and posttreatment.Results：Two patients in stiletto needle group,2 patients in knife needle group and 1 patient in voltaren group lost to follow-up.One hundred and eight patients in the 3 groups were followed up for 28-35 days with a median of 30 days,and no adverse reactions were found.There was no statistical difference in the displacement values,banana area ratio,tenderness values and VAS scores of knee-joint soft tissue and JOA scores between the 3 groups before treatment（5.61 ＋/-0.50,5.80＋/-0.65,5.67＋/-0.68 mm,F=0.877,P=0.41 9;72.01 ＋/-3.23,70.92＋/-3.72,71 .48＋/-5.87%,F=0.546,P=0.581;27.44 ＋/-5.1 9,27.24 ＋/-7.64,29.50 ＋/-5.49 N,F =1 .532,P=0.221;4.65 ＋/-0.71 ,4.28 ＋/-0.77,4.36＋/-0.85 points,F=2.283,P=0.1 07;72.36 ＋/-5.00,71 .67 ＋/-3.96,71 .81 ＋/-4.50 points,F=0.239,P=0.788）. There was statistical difference in the displacement values,banana area ratio,tenderness values and VAS scores of knee-joint soft tissue between the 3 groups at 1 month after the end of the treatment（7.49 ＋/-0.52,6.69 ＋/-0.68,6.52 ＋/-0.74 mm,F=32.280,P=0.000;58.95 ＋/-4.50,61 .66 ＋/-4.02,64.24 ＋/-6.52%,F=1 4.095,P=0.001;46.06 ＋/-6.76,36.55 ＋/-8.1 3,36.46 ＋/-6.1 7 N,F=31 .01 5,P=0.000;0.76＋/-0.62,2.06 ＋/-0.76,2.64＋/-0.71 points,F=58.1 1 7,P=0.000）.There was no statistical difference in the JOA scores between the 3 groups（89.72＋/-8.1 0,87.50＋/-6.27,85.69＋/-7.67 points,F=3.965,P=0.1 38）.The displacement values of knee-joint soft tissue increased in the 3 groups at 1 month after the end of treatment compared to pre-treatment （t=-1 8.395,P=0.000;t=-1 6.693,P=0.000;t=-1 1 .684,P=0.000）.The displacement values of knee -joint soft tissue were higher in stiletto needle group compared to knife needle group and voltaren group（P=0.000;P=0.000）and there was no statistical differ-ence between knife needle group and voltaren group（P=0.1 53）.The banana area ratio decreased in the 3 groups after treament compared to pre-treatment（t=23.1 48,P=0.000;t=21 .909,P=0.000;t=-1 3.081 ,P=0.000）.The banana area ratio was lower in stiletto needle group compared to voltaren group（P=0.001 ）,and there was no statistical difference in the banana area ratio between stiletto needle group and knife needle group（P=0.075）and between knife needle group and voltaren group（P=0.41 2）.The tenderness values increased in the 3 groups after treatment compared to pre-treatment（t=-21 .091 ,P=0.000;t=-1 1 .338,P=0.000;t=-1 0.91 7,P=0.000）, and the tenderness values were higher in stiletto needle group compared to knife needle and voltaren group（P=0.000;P=0.001 ）while there was no statistical difference between knife needle group and voltaren group（P=0.848）.The VAS scores decreased in the 3 groups after treatment compared to pre-treatment（t=30.1 38,P=0.000;t=21 .622,P=0.000;t=1 2.552,P=0.000）,and the VAS scores were lower in stiletto needle group compared to knife needle group and voltaren group（P=0.000;P=0.000）and were lower in knife needle group compared to voltaren group（P=0.01 2）.Conclusion：Stiletto needle release,knife needle release and external application of votalin emulgel are similar to each other in the short-term clinical comprehensive curative effects in treatment of early-middle KOA,however,the stiletto needle release can better relieve the knee pain,so it is worthy of popularizing in clinic.