内外侧膝眼穴超声药物透入治疗膝关节骨关节炎所致慢性疼痛的临床研究

Clinical study on treatment of chronic pain caused by osteoarthritis of knee joint by ultrasound drug penetration of medial and lateral knee acupoints

目的探讨内外侧膝眼穴超声透入双氯芬酸二乙胺乳胶剂治疗膝关节骨关节炎(KOA)导致的慢性疼痛临床疗效情况。方法选取2019年10月至2020年10月开封市人民医院收治的80例KOA所致慢性疼痛患者,采用随机数字表法将其随机分为观察组和对照组,每组40例。对照组在患肢痛处局部外用双氯芬酸二乙胺乳胶剂治疗,观察组在此基础上联合患肢内外侧膝眼穴超声透入双氯芬酸二乙胺乳胶剂治疗,所有对象均治疗5 d。比较两组治疗后临床疗效;比较两组治疗前及治疗第1、3、5天后采用视觉模拟量表(VAS)评估患者主观疼痛情况;比较两组治疗前和治疗5 d后评价受试者病情严重程度(Lequesne指数)、患膝功能状况[日本骨科协会(JOA)KOA治疗效果判定标准(以下简称JOA评分)]及生活质量状况[关节炎影响测量量表2(AIMS2)],并测定红细胞沉降率(ESR)及血清C反应蛋白(CRP)、基质金属蛋白酶-9(MMP-9)水平。最后汇总两组不良反应发生情况。结果观察组治疗后总有效率较对照组高(95.0%vs.80.0%)(P<0.05)。两组治疗后VAS评分均随治疗时间的延长而逐渐降低(P<0.05),且观察组治疗第1、3、5天后VAS评分均较同期对照组更低(P<0.05)。两组治疗后Lequesne评分和AIMS2评分均低于本组治疗前,而JOA评分则增高(P<0.05);但观察组治疗后Lequesne评分和AIMS2评分较对照组同期更低,而JOA评分更高(P<0.05)。两组治疗后ESR及血清CRP、MMP-9水平较本组治疗前下降,且观察组治疗后ESR及血清CRP、MMP-9水平低于同期对照组(P<0.05)。结论应用内外侧膝眼穴超声透入双氯芬酸二乙胺乳胶剂治疗KOA所致慢性疼痛的整体疗效确切,能够迅速、有效地缓解疼痛,稳定病情,改善患膝功能,提高患者生活质量,延缓疾病进展,这可能与该治疗方案能够显著抑制体内炎症反应有关。

【Objective】To investigate the clinical efficacy of diclofenac diethylamine emulsion through ultrasound in medial and lateral knee acupoints for the treatment of chronic pain caused by knee osteoarthritis(KOA).【Methods】Eighty patients with chronic pain caused by KOA treated in Kaifeng People's Hospital from October 2019 to October 2020 were randomly divided into the observation group(n=40)and the control group(n=40).The control group was treated with diclofenac diethylamine emulsion locally and externally at the site of limb pain,and the observation group was treated with diclofenac diethylamine emulsion through ultrasonic penetration at the medial and lateral knee of the affected limb.The clinical effect of the two groups was compared.The subjective pain was assessed by Visual Analogue Scale(VAS)before treatment and 1,3,5 days after treatment.Before and 5 days after treatment,the severity of illness(Lequesne index),knee function[Japan Orthopaedic Association KOA treatment effect judgment standard(JOA score)],and the quality of life[Arthritis Impact Measurement Scale 2(AIMS 2)]of the participants were assessed;the levels of C reactive protein(CRP)and matrix metalloproteinase-9(MMP-9)in serum and erythrocyte sedimentation rate were measured.Finally,two groups of side effects were summarized.【Results】The total effective rate of the observation group was 95.0%(38/40),higher than that of the control group(80.0%,32/40)(P<0.05).VAS Scores of both groups decreased gradually with the time of treatment(P<0.05).The VAS scores of pain in the observation group were significantly lower than those in the control group 1,3 and 5 days after treatment(P<0.05).After treatment,both Lequesne score and AIMS 2 score were significantly lower than those before treatment(P<0.05),and both JOA score were significantly higher(P<0.05),but after treatment,both Lequesne score and AIMS 2 score in the observation group were significantly lower than those in the control group(P<0.05),JOA score was significantly higher(P<0.05).After treatment,ESR,CRP and MMP-9 in serum of the two groups were significantly decreased(P<0.05),and Esr,CRP and MMP-9 in serum of the observation group were significantly lower than those of the control group(P<0.05).【Conclusion】The overall efficacy of diclofenac diethylamine emulsion in the treatment of KOA-induced chronic pain by ultrasound penetration of medial and lateral knee acupoints is accurate,which can rapidly and effectively relieve pain,stabilize the disease,improve the knee function and improve the quality of life of patients,the delay in disease progression may be related to the fact that the treatment significantly inhibits the inflammatory response in the body.