综合疗法治疗膝骨性关节炎100例的疗效观察

Effect observation on treating 100 cases of knee osteoarthritis by comprehensive therapy

目的:观察以疼痛介入治疗为特色的综合疗法治疗膝骨性关节炎肿痛畸形的临床疗效和安全性。方法:选取2015年1月-2016年12月我院住院治疗的膝骨性关节炎患者200例,按随机数字表法分为治疗组100例、对照组100例,治疗组给予洛索洛芬抗炎镇痛,60mg,2次/d;泮托拉唑护胃,40mg,1次/d;碳酸钙D3片1g/d及阿法骨化醇0.5μg/d,抗骨质疏松;硫酸氨基葡萄糖0.5g/次,2次/d。中药煎剂辨证论治,肝肾亏虚型表现为膝关节疼痛怕冷,酸软无力,纳可,大小便基本正常,舌红苔白脉细,用独活寄生汤加味水煎服,1剂/d,饭后服,2~3次/d。每晚睡前加服我院制剂"风湿痹痛丸"5g。,主要针对肿胀严重的膝关节行关节腔灌洗治疗,一般每个膝关节只做2~3次/年。关节腔灌洗治疗后2d进行内热针治疗,目的是消除关节周围软组织炎症,改善肌腱功能,恢复关节力学平衡。每个膝关节做2~4次,一般把膝关节治疗部位分为内侧面、外侧面、髌骨上部、髌骨下部,每天做一个部位,第2天休息,第3天做第二个部位。若治疗后2个月关节仍肿痛,可再做1次。每月复查肝肾功能和血常规。对照组与上述治疗基本相同,但不采用关节腔灌洗治疗和内热针治疗。两组均以3个月为1个疗程。结果:治疗组显效率85%,对照组显效率61%,治疗组服用抗炎镇痛药少于对照组,膝关节评分优于对照组,未出现严重不良反应。结论:以疼痛介入治疗为特色的四联疗法优于单纯药物加理疗方法,安全可靠。

Objective: To observe the clinical efficacy and safety of comprehensive therapy with pain intervention on knee osteoarthritis swelling and pain deformity. Methods: 200 cases of knee osteoarthritis treated in our hospital from January 2015 to December 2016 were selected and randomly divided into the treatment group and the control group, with 100 cases in each group. The treatment group received anti-inflammatory and analgesic loxoprofen, 60 mg, twice daily, pantoprazole to protect the stomach, 40 mg, once daily, Calcium Carbonate and Vitamin D3 tablets 1 g/d and alfacalcidol 0.5μg/d to anti-osteoporosis, glucosamine sulfate, 0.5 g/time, twice daily. TCM decoction was given based on syndrome differentiation and treatment, liver and kidney deficiency type showed knee pain cold, numbness, urine and defecation was basically normal, red tongue, white veins fine, so the Duhuo Jisheng decoction was prescribed, 1 decoction after meals every day, 2 ~ 3 times daily. Every night, Fengshi Bitong Wan that made by our hospital was given before going to bed, 5 g. Severe swelling of the knee joint was given lavage treatment, 2 ~ 3 times a year. After 2 days, the joint lavage treatment, the internal heat needle was used to eliminate the soft tissue inflammation around the joint, improve the tendon function, and restore the joint mechanical balance. Every knee joint was treated 2 ~ 4 times. The knee joint was divided into the medial surface, the lateral surface, the upper patella, the patella, the lower part of the knee, one site was treated every day, the second day was for rest, on the third day, the second part was treated. If the joint was still swollen and painful 2 months later, it could be done again. The function of liver and kidney and blood routine was reviewed every month. The control group received similar treatment except the joint lavage treatment and the internal heat needle. 3 months were of one treatment course. Results: The obvious effective rate of the treatment group was 85% and 61% in the control group. The treatment group took less anti-inflammatory and analgesic drug and the knee score was better than that in the control group. there was no severe side effect. Conclusion: The quadruple therapy characterized by pain intervention therapy was superior to simple medicine plus physiotherapy, and it was safe and reliable.