超声促透张氏百草膏联合富血小板血浆治疗膝关节骨关节炎的临床观察

Clinical Observation of Ultrasonic Penetration Zhang's Baicao Paste Combined with Platelet-Rich Plasma on the Treatment of Knee Osteoarthritis

目的:探讨超声促透张氏百草膏联合富血小板血浆(PRP)用于膝关节骨关节炎的临床疗效及作用机制。方法:选取膝关节骨关节炎患者160例,采用随机数字表法样本量按1∶1∶1∶1随机分为4组,张氏百草膏组(A组)、PRP关节腔注射组(B组)、低频超声辅助张氏百草膏组(C组)及低频超声辅助张氏百草膏+关节腔注射PRP组(D组)各40例,连续治疗5周,随访1年,记录并比较四组患者治疗前及治疗结束后的视觉模拟量表(VAS)评分和西安大略和麦克马斯特大学(WOMAC)骨关节炎指数评分;比较分析四组患者治疗前及治疗结束后的第3,6,12个月关节积液IL-1β、TNF-α水平,评定患者的临床疗效。结果:VAS及WOMAC评分组内比较,治疗后四组VAS评分均低于治疗前,差异有统计学意义(P<0.05);组间比较,治疗后低频超声辅助张氏百草膏+关节腔注射PRP组VAS评分低于其他三组(P<0.05)。关节液TNF-α、IL-1β水平组内比较,四组患者治疗后第3,6,12个月关节液TNF-α、IL-1β水平均低于治疗前,差异有统计学意义(P<0.05);组间比较,治疗后第3,6,12个月低频超声辅助张氏百草膏+关节腔注射PRP组患者关节液TNF-α、IL-1β水平均低于其他组,差异有统计学意义(P<0.05)。结论:低频超声透入可以提高张氏百草膏的临床疗效,超声促透张氏百草膏与富血小板血浆联合治疗膝关节骨关节炎临床疗效优于单一方法治疗的PRP关节腔注射或张氏百草膏,而且联合治疗可以持续减轻患者炎症反应。

Objective:To investigate the clinical efficacy and mechanism of ultrasonic penetration of Zhang's Baicao paste combined with platelet-rich plasma(PRP)in the treatment of knee osteoarthritis.Methods:A total of 160 patients with knee osteoarthritis were randomly divided into four groups:Zhang's Baicao paste group(group A),PRP intra-articular injection group(group B),low-frequency ultrasound-assisted Zhang's Baicao paste group(group C),and low-frequency ultrasound-assisted Zhang's Baicao paste+PRP intra-articular injection group(group D),with 40 cases in each group.The visual analoge scale(VAS)scores and Western Ontario and McMaster Universities(WOMAC)osteoarthritis index scores were recorded and compared before and after 5 weeks of treatment,followed by 1-year follow-up.The levels of interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)in joint effusion were compared among the four groups before treatment and at 3,6,and 12 months after treatment to evaluate the clinical efficacy.Results:VAS and WOMAC scores:Within-group comparison showed that VAS scores in all four groups were significantly lower after treatment compared to that before treatment(P<0.05).Between-group comparison demonstrated that VAS scores in the low-frequency ultrasound-assisted Zhang's Baicao paste+PRP injection group were significantly lower than those in the other three groups after treatment(P<0.05).Levels of TNF-αand IL-1βin joint fluid:Within-group comparison revealed that the levels of TNF-αand IL-1βin joint fluid were significantly lower at 3,6,and 12 months after treatment compared to those before treatment in all four groups(P<0.05).Between-group comparison showed that the levels of TNF-αand IL-1βin joint fluid were significantly lower in the low-frequency ultrasound-assisted Zhang's Baicao paste+PRP injection group compared to the other groups at 3,6,and 12 months after treatment(P<0.05).Conclusion:Low-frequency ultrasound penetration can enhance the clinical efficacy of Zhang's Baicao paste.The combined treatment of low-frequency ultrasound-assisted Zhang's Baicao paste with PRP intra-articular injection demonstrates superior clinical efficacy compared to PRP alone or Zhang's Baicao paste alone in the treatment of knee osteoarthritis.Moreover,this combination therapy can continuously reduce the inflammatory response in patients.