中药熏洗、针灸辅助腔内注射治疗膝关节骨性关节炎临床研究

Effect of Fumigating and Washing with Traditional Chinese Medicine,Acupuncture and Moxibustion Assisted Injection Inside Cavity on Clinical Symptoms and Joint Function of Patients with Knee Osteoarthritis

目的:探讨中药熏蒸、针灸辅助腔内注射对膝关节骨性关节炎患者症状及关节功能的影响。方法:回顾性病例研究,将2018年3月~2019年3月收治的132例膝关节骨性关节炎患者按治疗方式分为传统组(玻璃酸钠腔内注射,n=62)与联合组(中药熏洗、针灸辅助玻璃酸纳腔内注射,n=71),均连续治疗4周,比较两组临床疗效及治疗前后中医症状、膝关节疼痛程度、膝关节功能、关节活动度及血清炎症因子水平[白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]的变化,观测治疗不良反应发生情况。结果:联合组疗效分级优于传统组(P<0.05),治疗总有效率高于传统组(P<0.05);治疗前,两组各中医症状、体征积分,Lysholm膝关节功能量表评分及血清各炎症因子水平比较差异无统计学意义(P>0.05),治疗结束3个月,联合组关节疼痛、关节肿胀、晨僵、屈伸不利、腰膝酸软积分及血清炎症因子水平低于传统组(P<0.05),Lysholm膝关节功能量表评分高于传统组(P<0.05);治疗前,两组膝关节疼痛程度、关节活动度比较差异无统计学意义(P>0.05),疗程结束、治疗后3个月,联合组膝关节疼痛评分低于传统组,关节活动度高于传统组(P<0.05);两组治疗期间均未发生不良反应(P>0.05)。结论:中药熏洗、针灸辅助腔内注射玻璃酸钠治疗膝关节骨性关节炎整体疗效优于单用玻璃酸钠,可明显改善患者症状及体征,延缓关节软骨退变,减轻膝关节疼痛,改善关节功能。

Objective:To investigate the effect of fumigating and washing with traditional Chinese medicine(TCM),acupuncture and moxibustion assisted injection inside cavity on clinical symptoms and joint function of patients with knee osteoarthritis(KOA).Methods:This was a retrospective case-controlled study.132 patients with KOA admitted between March 2018 and March 2019 were divided into traditional group(injection of sodium hyaluronate inside cavity,n=62) and combined group(fumigating and washing with TCM,acupuncture and moxibustion assisted injection inside cavity,n=71).All subjects were treated for 4 weeks.The clinical efficacy,changes in TCM symptoms,knee joint pain,knee function,range of motion and levels of serum inflammatory factors [interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)] before and after treatment were compared between the two groups.The occurrence of adverse reactions was observed.Results:The grade of efficacy of the combined group was better than that of the traditional group(P < 0.05),and the total response rate was higher than that of the traditional group(P < 0.05).Before treatment,there was no significant difference in TCM symptoms,scores of signs,Lysholm knee function scale score or the level of each serum inflammatory factor(P > 0.05).At 3 months after treatment,the scores of joint pain,joint swelling,morning stiffness,poor flexion or extension,soreness and weakness of waist and knees and levels of serum inflammatory factors in the combined group were lower than those in the traditional group(P < 0.05),while the score of Lysholm knee joint function scale was higher than the traditional group(P < 0.05).Before treatment,there was no significant difference in knee joint pain or range of motion between the two groups(P > 0.05).The knee pain scores of the combined group were lower than those of the traditional group,and the range of motion was larger than the traditional group at the end of treatment and at 3 months after treatment(P < 0.05).No adverse reactions occurred during the treatment(P > 0.05).Conclusion:The overall curative effect of fumigating and washing with TCM,acupuncture and moxibustion assisted injection inside cavity is better than that of injection of sodium hyaluronate inside cavity alone for the treatment of KOA.The former can significantly improve the symptoms and signs of patients,delay the degeneration of articular cartilage,reduce knee pain and improve joint function.