膝骨性关节炎中医证型与关节镜下滑膜病变的相关性研究

Correlation of Traditional Chinese Medical Syndrome Patterns of Knee Osteoarthritis with Synovial Pathological Changes Under Arthroscope

【目的】探讨膝骨性关节炎(KOA)的不同中医证型与关节镜下滑膜病变程度的相关性。【方法】选取80例膝骨性关节炎患者,由2名高级职称医师对患者进行中医辨证分型。所有患者均行关节镜手术治疗,对不同中医证型膝骨性关节炎的关节镜下滑膜病变程度进行分级,并对数据进行统计学分析处理。【结果】肝肾阴虚型、气滞血瘀型、脾肾阳虚型和风寒湿痹型等4种证型间滑膜增生改变程度比较(非参数秩和检验),差异有统计学意义(P<0.05);LSD检验方法多重比较发现,脾肾阳虚型的程度分级较肝肾阴虚型、气滞血瘀型、风寒湿痹型等证型均高,差异均有统计学意义(P<0.05)。【结论】关节镜下滑膜病变程度可作为评价膝骨性关节炎严重性的一项重要指标,可在一定程度上为膝骨性关节炎的辨证施治提供客观依据。

Objective To investigate the correlation of traditional Chinese medical syndrome patterns of knee osteoarthritis （KOA） with the synovial pathological changes under arthroscope. Methods Eighty KOA patients were enrolled into the study, and the syndrome types were differentiated by two doctors with senior titles. All patients underwent arthroscopic operation therapy. The severity of synovial pathological changes under arthroscope in KOA patients with different syndrome types was classified, and then the data was statistically analyzed. Results The non-parametric Wilcoxon test results showed that the differences of synovial pathological changes were significant in 4 syndrome types of liver-kidney yin deficiency, qi stagnation and blood stasis, spleen- kidney yang deficiency, and wind-cold-damp arthralgia（P 〈 0.05）. LSD multiple comparison test results showed that patients with spleen-kidney yang deficiency had severer synovial changes than the other 3 types, and the difference was statistically significant（P〈 0.05）. Conclusion The synovium pathological changes under arthroscope carl be used as an important diagnostic indicator for KOA severity evaluation, and the results will provide an objective basis for syndrome differentiation and treatment to some extent.