中医三联序贯疗法与注射用骨肽治疗膝骨性关节炎的临床对照研究

Case-control study of Chinese medicine sequential triple therapeutic scheme and ossotide injection in the treatment of osteoarthritis

目的比较中医三联序贯疗法与注射用骨肽治疗膝骨性关节炎的临床疗效。方法选取佛山市第二人民医院骨科2015年6月至2016年11月收治的102例膝骨性关节炎患者为研究对象,采用电脑随机对照表法,随机分对照组和观察组,每组51例,对照组给予注射用骨肽100 mg静脉滴注,1次/d;观察组给予中医三联序贯干预,第一步中药熏洗,第二步经穴推拿,第三步药膏贴,治疗前和治疗8周后测定西安大略和麦克马斯特大学骨关节炎指数(WOMAC骨性关节炎指数评分),骨性关节炎指数评分,包括疼痛、僵硬和关节功能等,收集血液样本,采用酶联免疫法测定血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)与肿瘤坏死因子-α(TNF-α)数值,比较临床疗效。结果治疗后,对照组和观察组患者的疼痛评分分别为(1.53±0.56)分、(0.91±0.47)分,僵硬评分分别为(0.80±0.43)分、(0.53±0.41)分,关节功能评分分别为(3.39±1.46)分、(2.08±1.20)分,总分分别为(5.97±2.84)分、(3.51±2.33)分,以上各项评分对照组均高于观察组,差异有统计学意义(P<0.05);治疗后,对照组和观察组患者的血清IL-1β分别为(79.36±7.14)μg/m L、(74.15±6.57)μg/m L,血清IL-6分别为(135.62±21.52)mg/m L、(116.30±18.65)mg/m L,血清TNF-α分别为(11.40±4.11)μg/m L、(7.14±3.52)μg/m L,以上各项指标对照组均高于观察组,差异有统计学意义(P<0.05);对照组患者的治疗总有效率为76.47%,低于观察组的92.16%,差异有统计学意义(P<0.05)。结论与注射用骨肽比较,中医三联序贯疗法更有助于改善骨性关节炎患者的关节功能,降低炎性介质,提高治疗效果,值得临床推广应用。

Objective To investigate the effects of Chinese medicine sequential triple therapeutic scheme and ossotide injection in the treatment of osteoarthritis. Methods A total of 102 cases of knee osteoarthritis patients, who admitted to Department of Orthopedics of the Second People＇s Hospital of Guangdong from June 2015 to November2016, were included divided into the two groups, with 51 cases in each group. The control group received ossotide injection of 100 mg intravenous drip, and the study group received Chinese medicine sequential triple therapeutic scheme, including the first step of herbal fumigation, second step of acupoint massage, third step of plaster. The scores of Western Ontario and Mc Master Universities（WOMAC） osteoarthritis indexs, including pain, stiffness and joint function were compared before and after the treatment. Blood samples were collected to determine the levels of interleukin-1β（IL-1β）, interleukin-6（IL-6） and tumor necrosis factor α（TNF-α） by ELISA, and clinical effect was also compared. Results After the treatment, the levels of pain score, stiff score, joint function scores, total scores in the control group were（1.53 ±0.56）,（0.80 ± 0.43）,（3.39 ± 1.46）,（5.97 ± 2.84）, respectively, which were significantly higher than corresponding（0.91 ±0.47）,（0.53±0.41）,（2.08±1.20）,（3.51±2.33） in the observation group（P〈0.05）; the levels of serum IL-1β, IL-6, TNF-αin the control group were（79.36±7.14） mg/mL,（135.62±21.52） mg/mL,（11.40±4.11） μg/mL, respectively, which were significantly higher than corresponding（74.15±6.57） mg/mL,（116.30±18.65） mg/mL,（7.14±3.52） μg/mL in the observation group（P〈0.05）; the total effective rate was 76.47% in the control group versus 92.16% in the observation group（P〈0.05）. Conclusion Compared with ossotide injection, Chinese medicine sequential triple therapeutic scheme is helpful to improve the joint function of patients with osteoarthritis, reduce inflammatory mediators, and improve the therapeutic effect, which is worthy of popularization.