针刺联合玻璃酸钠关节腔注射治疗膝关节骨性关节炎的临床观察

Treatment of Knee Osteoarthritis with Acupuncture plus Intra-articular Injection of Sodium Hyaluronate

目的:观察针刺联合玻璃酸钠关节腔注射治疗膝关节骨性关节炎(KOA)的临床效果。方法:将150例KOA患者随机分为单用组和联合组,每组75例。单用组以髌骨外上缘及外缘中点作为进针点,抽吸无积液后关节腔注入玻璃酸钠注射液2mL,1次/周,共5次。联合组在关节腔注射基础上联合针刺治疗,取足三里、梁丘、阳陵泉、阴陵泉、膝阳关、犊鼻、内膝眼及血海,平补平泻法,留针30min;单膝病变者单侧针刺,双膝病变者双侧针刺,3~5次/周,共5周。于治疗前、治疗5周后,观察两组患者膝关节视觉模拟量尺(VAS)评分及骨关节炎指数(WOMAC)评分变化,并评价两组临床疗效。结果:与治疗前比较,治疗后两组患者VAS、WOMAC评分均降低(P<0.05);联合组降低幅度大于单用组(P<0.05)。联合组总有效率为93.33%(70/75),单用组总有效率为82.67%(62/75),联合组治疗效果优于单用组(P<0.05)。结论:针刺联合玻璃酸钠关节腔注射治疗KOA疗效确切,可改善患者膝关节功能,缓解临床症状,减轻疼痛,提高日常生活能力。

Objective To examine the clinical benefits of acupuncture combined with intra-articular injection of sodium hyaluronate for knee osteoarthritis（KOA）patients.Methods A total of 150 KOA patients were randomized into simple medication and acupuncture plus medication（combined treatment）groups（n=75 in each）.For all the patients,intra-articular injection of sodium hyaluronate（2 mL）was performed once a week for 5 weeks,and for patients of the combined treatment group,filiform needles were separately inserted into unilateral or bilateral Zusanli（ST 36）,Liangqiu（ST 34）,Yanglingquan（GB 34）,Yinlingquan（SP 9）,Xiyangguan（GB 33）,Dubi（ST 35）,Neixiyan（EX-LE 4）and Xuehai（SP 10）according to the focus,and manipulated with the uniform reinforcing and reducing technique,followed by retaining the needles for 30 min.The acupuncture treatment was given once every day or every other day,5 weeks in total.The visual analog scale（VAS）was used to assess the pain severity of kneejoint,and the Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）employed to assess the 1）pain severity during various positions or movements（20 points）,2）severity of joint stiffness（8 points）,and 3）difficulty in performing daily functional activities（68 points）.The therapeutic effect was evaluated according to the decreased level of WOMAC subscale scores and improvement of daily activities.Results After the treatment,the VAS scores of both medication and combined treatment groups were decreased significantly in comparison with their own pre-treatment in each group（P〈0.05）,and that of the combined treatment group was significantly lower than that of the medication group（P〈0.05）.WOMAC and daily activity findings showed that of the two 75 KOA patients in the medication and combined treatment groups,16（21.33%）and 32（42.67%）experienced marked improvement,46（61.33%）and 38（50.67%）were improved,and 13（17.33%）and 5（6.67%）ineffective,with the total effective rates being 82.67% and 93.33%,respectively.The therapeutic effect of the combined treatment group was apparently superior to that of the simple medication group（P〈0.05）.Conclusion Acupuncture combined with intraarticular injection of sodium hyaluronate is effective in improving KOA patients＇ pain severity and other symptoms as well as functional activities.