四妙散联合关节镜下射频消融治疗急性创伤性膝关节滑膜炎的疗效观察

Curative Effect of Simiaosan Combined with Radiofrequency Ablation in Treatment of Acute Traumatic Gonarthromeningitis Under Arthroscopy

目的:观察四妙散联合关节镜下射频消融治疗急性创伤性膝关节滑膜炎的临床疗效及对患者炎症标志物、膝关节功能的影响。方法:选取2017年2月至2018年11月在河南中医药大学第一附属医院就诊的92例急性创伤性膝关节滑膜炎患者,采取简单随机数字表法将其随机分成观察组与对照组,每组各46例。观察组采取四妙散联合关节镜下射频消融治疗,对照组口服尪痹片、滑膜炎颗粒、艾瑞昔布片,同时行关节镜下射频消融治疗。术后1个月时观察两组疗效。对两组术前及术后1个月时患膝关节疼痛、肿胀程度进行评估,并于术前和术后1个月时采用Lysholm膝关节评分系统(lysholm knee score scale,LKSS)评价患膝关节功能,同时测量患膝关节活动度,使用魏氏法分析红细胞沉降率(erythrocyte sedimentation rate,ESR),采取免疫比浊法检测超敏-C反应蛋白(hypersensitive C-reactive protein,hs-CRP)。且观察两组不良反应及并发症发生情况。结果:治疗后与对照组比较,观察组总有效率明显高于对照组(P<0. 05)。两组治疗后患膝关节疼痛视觉模拟评分法(visual analogue scale,VAS)评分均较本组治疗前明显降低(P<0. 05),关节肿胀评分则均明显升高(P<0. 05);治疗后,观察组患膝关节疼痛VAS评分较对照组同期明显更低(P<0. 05),关节肿胀评分明显更高(P<0. 05)。两组治疗后患膝关节LKSS评分及活动度均较本组治疗前明显增加(P<0. 05),观察组改善更明显(P<0. 05)。两组治疗后外周血ESR及血清hs-CRP浓度均较本组治疗前明显下降(P<0. 05),且观察组降低更明显(P<0. 05)。观察组在四妙散治疗过程中未见明显副反应。两组术后并发症发生率对比差异无统计学意义。结论:四妙散联合关节镜下射频消融治疗急性创伤性膝关节滑膜炎可取得明显的临床疗效,患者的患膝关节功能明显改善,其机制可能与抑制体内炎症反应有关。

Objective: To investigate the clinical efficacy of Simiaosan combined with arthroscopic radiofrequency ablation in the treatment of acute traumatic knee synovitis and its effects on inflammatory markers and knee joint function. Method: A total of 92 patients with acute traumatic knee synovitis who were treated in our hospital from February 2017 to November 2018 were randomly divided into observation group and control group,with 46 cases in each group. The patients in observation group were treated with Simiaosan combined with arthroscopic radiofrequency ablation, while the patients in control group were treated radiofrequency ablation combined with Gubi tablet,synovitis granule and imrecoxib tablets. The efficacy in the two groups was observed one month after operation. The degree of pain and the swelling of knee joint were evaluated before and one month after operation,and the function of knee joint was evaluated by lysholm knee score system(LKSS)before and one month after operation. And at the same time,the knee joint activity was measured,erythrocyte sedimentation rate(ESR)was analyzed by Wechsler’s method,and hypersensitivity Creactive protein(hs-CRP)was detected by immunoturbidimetry. The adverse reactions and complications of the two groups were observed. Result: Compared with control group after treatment,the total effective rate in observation group was significantly higher than that in control group,with statistically significant differences(P<0. 05). The visual analogue scale(VAS)scores of knee pain in both groups after treatment were significantly lower than those before treatment(P<0. 05),while the joint swelling scores were significantly higher(P<0. 05). After treatment,the VAS score of knee pain in observation group was significantly lower than that of control group at the same time(P<0. 05),while the joint swelling score was significantly higher(P<0. 05). After treatment,the LKSS score and the range of motion of the affected knee joints in both groups were significantly increased compared with those before treatment(P<0. 05),but with more significant improvement in observation group(P<0. 05). The levels of ESR in peripheral blood and hs-CRP in serum of the two groups were significantly lower than those before treatment(P<0. 05),especially in observation group(P<0. 05). No obvious side effects were observed in observation group during the treatment with Simiaosan. There was no significant difference in the incidence of complications between the two groups. Conclusion: The treatment of Simiaosan combined with radiofrequency ablation under arthroscope has a significant efficacy in the treatment of acute traumatic gonarthromeningitis. The knee joint function of the patients was significantly improved,and the mechanism may be related to the inhibition of inflammatory reaction in vivo.