温针灸配合推拿治疗膝关节骨性关节炎的疗效及对血清和关节液IL-17的影响

Effect of Needling-Warming Moxibustion Combined with Tuina in Treatment of Knee Osteoarthritis and Its Influence on IL-17 in Serum and in Synovial Fluid

目的:探讨温针灸配合推拿治疗膝关节骨性关节炎的疗效及对血清和关节液白介素-17(IL-17)的影响。方法:选取我院骨科收治的膝关节骨性关节炎患者110例,根据治疗方式分为治疗组(n=60)和对照组(n=50),对照组给予推拿治疗,治疗组在对照组的基础上配合温针灸治疗,5次为1个疗程,两组均连续治疗4个疗程。比较两组临床治疗效果;评定并比较两组治疗前后临床症状、活动能力及膝关节疼痛情况;检测并比较两组治疗前后血清和关节液IL-17水平变化。结果:治疗后治疗组总有效率为78.33%,显著高于对照组的62.00%(P<0.05);与治疗前比较,治疗后两组晨僵、关节肿胀、关节压痛、关节活动障碍等临床症状评分和上/下楼梯、下蹲屈膝及行不平坦地面等活动能力评分均显著降低,且治疗组低于对照组(P<0.05或P<0.01);与治疗前比较,治疗后治疗组VAS评分显著降低,且低于对照组(P<0.01);与治疗前比较,治疗后两组血清和关节液IL-17水平均显著降低,且治疗组低于对照组(P<0.05或P<0.01)。结论:温针灸配合推拿能显著降低膝关节骨性关节炎患者血清和关节液IL-17水平,缓解患者疼痛,改善其临床症状和活动能力,效果显著优于推拿单独治疗。

Objective： To explore the clinical efficacy of needling-warming moxibustion combined with tuina in treatment of knee osteoarthritis and its influence on interleukin-17（ IL-17） in serum and in synovial fluid.Methods： 110 cases of knee osteoarthritis were randomly divided into the treatment group（ n = 60） and the control group（ n = 50）. The control group was treated with tuina therapy; on which basis,the treatment group was also treated with needling-warming moxibustion; 5 treatments were taken as one course,and the two groups were treated for continuous four courses. The clinical efficacy,the improvements of clinical symptoms,activity ability,and knee joint pain,as well as IL-17 level in serum and in synovial fluid were compared before and after treatment in the two groups. Results： After treatment,the total effective rate of the treatment group was 78. 33%,which was significantly higher than 62. 00% of the control group（ P〈0. 05）. The scores of clinical symptom,such as morning stiffness,joint swelling,joint tenderness,and articular dyskinesia; as well as the activity scores of walking up/down stairs,squating,and walking on uneven ground,decreased significantly,and the the decrease were more obvious in the treatment group than those in the control group（ P〈0. 05,P〈0. 01）. The VAS score was greatly lowered in the treatment group after treatment,which was significantly lower than that in the control group（ P〈0. 01）. IL-17 level was also remarkably decreased in the two groups after treatment,and the decrease was more significant in the treatment group than that in the control group（ P〈0. 05,P〈0. 01）. Conclusion： Needling-warming moxibustion combined with tuina can significantly reduce the IL-17 level in serum and in synovial fluid of the patients with knee osteoarthritis,it can alleviate the pain,improve the clinical symptoms and activity ability,and its efficacy is better than single tuina therapy.