针刀与温针灸联合常规疗法治疗膝骨关节炎临床研究

Clinical Study on Acupotomy and Warming-Needle Moxibustion Combined with Routine Therapy for Knee Osteoarthritis

目的:观察在常规疗法基础上加用针刀联合温针灸治疗风寒湿痹型膝骨关节炎患者的临床效果。方法:纳入80例风寒湿痹型膝骨关节炎患者,根据治疗方式的不同分为2组各40例,2组均予营养软骨细胞的药物治疗,同时外敷药膏。对照组应用温针灸治疗,研究组应用针刀联合温针灸治疗。2组均治疗4周。比较2组的临床效果,观察治疗前后临床症状、骨代谢指标[骨钙素(BGP)、降钙素(CT)、骨保护素(OPG)]与炎性因子[白细胞介素-1(IL-1)、胰岛素样生长因子-1(IGF-1)、纤维细胞生长因子-2(FGF-2)、转化生长因子-β(TGF-β)]的变化。结果:治疗4周后,研究组临床疗效总有效率97.5%,对照组总有效率77.5%,2组比较,差异有统计学意义(P<0.01)。2组头晕耳鸣、动作牵强、关节隐痛、腰膝酸痛、活动不利症状评分均较治疗前下降(P<0.05),研究组5项症状评分均低于对照组(P<0.05)。2组BGP、OPG水平均较治疗前升高,差异均有统计学意义(P<0.05)。2组治疗前后CT水平比较,差异均无统计学意义(P>0.05)。研究组BGP、OPG水平均高于对照组,差异均有统计学意义(P<0.05)。2组IL-1水平均较治疗前降低,IGF-1、FGF-2、TGF-β水平均较治疗前升高,差异均有统计学意义(P<0.05)。研究组IL-1水平低于对照组,IGF-1、FGF-2、TGF-β水平均高于对照组,差异均有统计学意义(P<0.05)。结论:在常规疗法基础上加用针刀联合温针灸治疗风寒湿痹型膝骨关节炎效果理想,可有效增加骨生成,减轻炎症反应,缓解临床症状,提高临床效果。

Objective:To observe the clinical effect of the additional application of acupotomy and warming-needle moxibustion combined with routine therapy for knee osteoarthritis of wind-cold and fixed impediment type based on routine therapy.Methods:A total of 80 cases of patients with knee osteoarthritis were divided into two groups according to different treatment methods,with 40 cases in each group.Both groups were given drugs for nourishing chondrocytes and ointment for external application.The control group was treated with warming-needle moxibustion,and the study group was treated with acupotomy and warming-needle moxibustion.Both groups were treated for four weeks.The clinical effects in the two groups were compared.Before and after treatment,the changes in clinical symptoms,the bone metabolism indexes including bone Gla protein(BGP),calcitonin(CT) and osteoprotegerin(OPG),and the inflammatory factors including interleukin-1(IL-1),insulin-like growth factor-1(IGF-1),fibroblast growth factor-2(FGF-2) and transforming growth factor-β(TGF-β) were observed.Results:After four-week treatment,the total effective rate of clinical effect was 97.5% in the study group and77.5% in the control group,the difference being significant(P<0.01).The symptom scores of dizziness and tinnitus,strained movement,vague pain in joints,soreness and weakness of waist and knees and adverse events in the two groups were decreased when compared with those before treatment(P<0.05),the five symptom scores in the study group were lower than those in the control group(P<0.05).The levels of BGP and OPG in the two groups were increased when compared with those before treatment,differences being significant(P<0.05).There was no significant difference being found in the comparison of CT levels before and after treatment(P>0.05).The levels of BGP and OPG in the study group were higher than those in the control group,the difference being significant(P<0.05).The IL-1 levels in the two groups were decreased when compared with those before treatment,and the levels of IGF-1,FGF-2 and TGF-β were increased,differences being significant(P<0.05).The IL-1 level in the study group was lower than that in the control group,and the levels of IGF-1,FGF-2 and TGF-β were higher,differences being significant(P<0.05).Conclusion:Based on routine therapy,the additional application of acupotomy and warming-needle moxibustion has an ideal effect in treating knee osteoarthritis,and can effectively increase osteogenesis,relieve inflammatory responses and clinical symptoms,and improve clinical effect.