基于去神经化理论探讨针刀治疗膝骨关节炎临床研究

Discussion on Clinical Study of Acupotomy for Knee Osteoarthritis Based on the Denervation Theory

目的:观察去神经化理论指导下针刀治疗膝骨关节炎(KOA)的临床疗效。方法:选取56例KOA患者,按随机数字表法分为针刀组和针刺组各28例。针刀组在去神经化理论指导下给予针刀治疗,针刺组给予常规针刺联合电磁烤灯治疗。比较2组治疗前、治疗后及随访6个月疼痛视觉模拟评分法(VAS)评分、Lysholm膝关节功能评分和血清白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平,记录不良反应。结果:治疗后、随访6个月,针刀组VAS评分及跛行、关节绞索、承受重量、不稳定、疼痛、关节肿痛、上下楼、下蹲起立评分均低于同期针刺组(P<0.05);针刀组血清IL-1β、TNF-α水平均低于同期针刺组(P<0.05)。治疗期间,2组各有1例患者出现局部瘀点、瘀斑,给予复方七叶皂苷钠凝胶外涂后症状消失,2组均无晕针、局部皮肤感染等不良反应。结论:去神经化理论指导下运用针刀治疗KOA,可明显缓解患者疼痛,改善其膝关节功能,降低血清IL-1β、TNF-α水平,安全性高。

Objective:To observe the clinical effect of acupotomy for knee osteoarthritis(KOA)under the guidance of denervation theory.Methods:A total of 56 cases of KOA patients were selected and divided into the acupotomy group and the needling group according to the random number table method,28 cases in each group.The acupotomy group was treated with acupotomy under the guidance of denervation theory,and the needling group was given routine needling and electromagnetic hot lamp.Before treatment,after treatment,and during six-month follow-up,the scores of Visual Analogue Scale(VAS)of pain and Lysholm Knee Function Scale,as well as levels of interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)in serum were compared between the two groups.The adverse reactions were recorded.Results:After treatment and during six-month follow-up,the scores of VAS,claudication,joint interlocking,weight bearing,instability,pain,joint swelling and pain,going upstairs and downstairs,squatting and standing up in the acupotomy group were lower than those in the needling group in the same period(P<0.05),and levels of IL-1βand TNF-αin serum were lower(P<0.05).During treatment,there was one case of local petechia and ecchymosis in both groups respectively,and due to the external application of compound sudium aescinate gel,the symptoms disappeared.During treatment,there was no fainting during acupuncture and local skin infection in the two groups.Conclusion:Under the guidance of denervation theory,acupotomy in the treatment of KOA can significantly relieve pain,improve the knee joint function,and reduce levels of IL-1βand TNF-αin serum,with high safety.