温针灸联合小针刀治疗寒湿型膝骨性关节炎临床观察

Clinical Observation on Warming Needle Moxibustion Combined with Small Acupotomy in the Treatment of Cold-dampness Knee Osteoarthritis

目的观察温针灸联合小针刀治疗寒湿痹阻型膝骨性关节炎的临床疗效。方法将158例膝骨性关节炎患者采用分层区组随机化方法分为试验1组52例,试验2组53例,对照组53例。对照组采用双氯芬酸钠缓释片治疗,试验1组在对照组药物治疗基础上采用小针刀松解治疗,试验2组在对照组药物治疗基础上采用温针灸联合小针刀松解术进行治疗。比较3组患者治疗前后疼痛视觉模拟法VAS评分、Lysholm评分及相关性评价、检测膝关节液中的IL-1β、TNF-α和血清ESR、CRP情况。结果治疗前,3组之间VAS评分、Lysholm评分比较,均P>0.05,差异无统计学意义;治疗2周后、治疗4周后,3组VAS评分均明显降低,Lysholm评分均明显升高,且试验2组各项指标降低或升高幅度均明显优于试验1组,试验1组明显优于对照组,P<0.01。3组治疗前膝关节液中IL-1β以及TNF-α比较,均P>0.05,差异无统计学意义;治疗4周后,3组之间IL-1β以及TNF-α比较,均P<0.01,差异有统计学意义,IL-1β和TNF-α含量均显著低于治疗前,且试验2组<试验1组<对照组。3组治疗前血清中ESR以及CRP水平比较,均P>0.05,差异无统计学意义;治疗4周后,3组之间ESR以及CRP比较,均P<0.01,差异有统计学意义,ESR、CRP均显著低于治疗前,且试验2组<试验1组<对照组。结论温针灸联合小针刀治疗寒湿型膝骨性关节炎止痛效果明显、改善膝关节功能效果显著,且明显降低膝关节液中IL-1β、TNF-α和血清中ESR、CRP的水平。

Objective To observe the clinical effect of warming needle moxibustion combined with small acupotomy in the treatment of colddampness knee osteoarthritis.Methods 158 patients with knee osteoarthritis were randomly divided into clinical trial group 1(n=52),clinical trial group 2(n=53)and control group(n=53).The control group was treated with diclofenac sodium sustained-release tablets,the clinical trial group1 was treated with small acupotomy laxative treatment on the basis of drug treatment in the control group,and the clinical trial group 2 was treated with warming needle moxibustion combined with small acupotomy laxative treatment on the basis of drug treatment in the control group.Visual analogue scale(VAS)score,Lysholm score and correlation evaluation of pain before and after treatment were compared among the three groups(P<0.01).Il-1β,TNF-α and serum ESR and CRP levels were detected in knee joint fluid.Results before treatment,VAS score and Lysholm score were all P>0.05,and the difference was not statistically significant.After 2 weeks of treatment and4 weeks of treatment,VAS scores and Lysholm scores in the three groups were significantly decreased and Lysholm scores were significantly increased.Moreover,the reduction or increase amplitude of various indexes in clinical trial group 2 was significantly better than that in clinical trial group 1,and clinical trial group 1 was significantly better than that in the control group(P<0.01),and the difference was not statistically significant.Before treatment,IL-1β and TNF-α in knee joint fluid of the three groups were all P>0.05,and the difference was not statistically significant.After 4 weeks of treatment,the levels of IL-1β and TNF-α were significantly lower than those of the control group(P<0.01),and clinical trial group 2<clinical trial group 1<control group.The serum levels of ESR and CRP in the three groups before treatment were all P>0.05,and the difference was not statistically significant.After 4 weeks of treatment,the levels of ESR and CRP were significantly lower than those of the control group(P<0.01),and clinical trial group 2<clinical trial group 1<control group.Conclusion The therapeutic effect of warming needle moxibustion combined with small acupotomy on cold-dampness knee osteoarthritis is significant in analgesia and improvement of knee joint function,and the levels of IL-1β,TNF-α and ESR and CRP in knee joint fluid are significantly reduced.