经筋灸法配合独活寄生汤治疗风寒湿痹型膝骨性关节炎临床观察

Clinical Observation of Tendon Moxibustion Combined with Duhuo Jisheng Decoction for Treatment of Knee Osteoarthritis of Obstructive Syndrome Due to Wind,Cold and Dampness

【目的】观察经筋灸法配合独活寄生汤治疗风寒湿痹型膝骨性关节炎(KOA)的临床疗效。【方法】将90例风寒湿痹型KOA患者随机分为治疗组和对照组,每组各45例。对照组给予常规西药治疗,治疗组给予经筋灸法配合独活寄生汤治疗,疗程为14 d。观察2组患者治疗前后视觉模拟量表(VAS)评分、国际膝关节文献委员会(IKDC)评分,以及关节液中白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平的变化情况,并评价2组患者的临床疗效。【结果】(1)治疗2周后,治疗组的总有效率为91.11%(41/45),对照组为75.56%(34/45),治疗组的疗效明显优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者VAS评分均较治疗前明显降低(P<0.05),IKDC评分均较治疗前明显升高(P<0.05),且治疗组对VAS评分的降低作用及对IKDC评分的升高作用均明显优于对照组,差异均有统计学意义(P<0.05)。(3)治疗后,2组患者关节液中IL-6、TNF-α水平均较治疗前明显降低(P<0.05),且治疗组对IL-6、TNF-α水平的降低作用均明显优于对照组,差异均有统计学意义(P<0.05)。【结论】经筋灸法配合独活寄生汤治疗风寒湿痹型KOA疗效显著,能有效缓解膝关节疼痛症状,提高膝关节活动功能,其作用机制可能与降低IL-6、TNF-α水平有关。

Objective To observe the clinical effect of tendon moxibustion combined with Duhuo Jisheng Decoction in treating knee osteoarthritis of obstructive syndrome due to wind,cold and dampness.Methods Ninety knee osteoarthritis patients with obstructive syndrome due to wind,cold and dampness were randomly divided into treatment group(n=45)and control group(n=45).The control group was treated with conventional western medicine,and the treatment group was treated with tendon moxibustion combined with Duhuo Jisheng Decoction.The course of treatment for the two groups lasted 14 days.Before and after treatment,the scores of visual analogue scale(VAS)for joint pain,the scores of the International Knee Documentation Committee(IKDC)Subjective Knee Form,and the levels of interleukin 6(IL-6)and tumor necrosis factor alpha(TNF-α)in the synovial fluid of the two groups were examined.After treatment,the clinical efficacy was evaluated.Results(1)After 2 weeks of treatment,the total effective rate in the treatment group was 91.11%(41/45)and that in the control group was 75.56%(34/45).The clinical efficacy of the treatment group was significantly stronger than that of the control group,and the difference was statistically significant(P<0.05).(2)After treatment,the VAS scores in the two groups were decreased and the IKDC scores were increased in comparison with those before treatment(P<0.05),and the effects of the treatment group on decreasing VAS scores and on increasing IKDC scores were superior to those of the control group,the differences being statistically significant(P<0.05).(3)After treatment,the levels of IL-6 and TNF-αin the synovial fluid of the two groups were significantly lower than those before treatment,and the effects on decreasing the levels of IL-6 and TNF-αin the treatment group were significantly stronger than those in the control group,the difference being statistically significant(P<0.05).Conclusion The tendon moxibustion combined with Duhuo Jisheng Decoction can relieve the pain of knee joint and improve the knee joint movement,and the mechanism may be related with the decrease of IL-6 and TNF-α levels.