温针灸联合微针刀治疗膝骨关节炎临床研究

Clinical Study on Warming-Needle Moxibustion Combined with Micro Acupotomy for Knee Osteoarthritis

目的:观察温针灸联合微针刀治疗膝骨关节炎(KOA)的临床疗效。方法:选取80例KOA患者按随机信封法分为2组各40例。对照组予常规温针灸治疗,观察组在对照组基础上予微针刀治疗。比较2组治疗前后临床症状评分、膝骨关节炎指数(WOMAC)评分、膝关节活动度(ROM)、积液含量分级及血清指标[白细胞介素-6(IL-6)、基质金属蛋白酶-3(MMP-3)、基质金属蛋白酶抑制剂-1(TIMP-1)],并比较2组不良反应。结果:治疗前,2组各项临床症状评分比较,差异无统计学意义(P>0.05);治疗后,2组各项临床症状评分均降低(P<0.05),且观察组低于对照组(P<0.05)。治疗前,2组Lysholm评分、WOMAC评分、ROM比较,差异无统计学意义(P>0.05);治疗后,2组Lysholm评分均升高(P<0.05),WOMAC评分均降低(P<0.05),ROM均增大(P<0.05),且观察组Lysholm评分高于对照组(P<0.05),WOMAC评分低于对照组(P<0.05),ROM大于对照组(P<0.05)。治疗前,2组积液含量分级比较,差异无统计学意义(P>0.05);治疗后,2组积液含量Ⅰ级例数均增多(P<0.05),Ⅲ级、Ⅳ级例数均减少(P<0.05),且2组比较,差异有统计学意义(P<0.05)。治疗前,2组血清IL-6、MMP-3、TIMP-1水平比较,差异无统计学意义(P>0.05);治疗后,2组血清IL-6、MMP-3水平均降低(P<0.05),TIMP-1水平均升高(P<0.05),且观察组血清IL-6、MMP-3水平低于对照组,TIMP-1水平高于对照组(P<0.05)。治疗期间2组均未发生不良反应。结论:微针刀联合温针灸治疗KOA患者疗效显著,可改善临床症状及膝关节功能,提高ROM,减轻机体炎症反应,延缓软骨细胞退变,且具有一定安全性。

Objective:To observe the clinical effect of warming-needle moxibustion combined with micro acupotomy for knee osteoarthritis(KOA).Methods:A total of 80 cases of KOA patients were divided into two groups according to the random envelope method,with 40 cases in each group.The control group was treated with routine warming-needle moxibustion,and the observation group was additionally treated with micro acupotomy based on the treatment of the control group.Before and after treatment,the scores of clinical symptoms and Western Ontario and Mcmaster Universities Osteoarthritis Index(WOMAC),range of motion(ROM)of knee joint,classification of fluid content,and serum indexes including interleukin-6(IL-6),matrix metalloproteinase-3(MMP-3)and tissue inhibitor of metalloproteinases-1(TIMP-1)were compared between the two groups.The adverse reactions were compared between the two groups.Results:Before treatment,there was no significant difference being found in the comparison of scores of clinical symptoms between the two groups(P>0.05).After treatment,the scores of each clinical symptom were decreased(P<0.05),and the scores in the observation group were lower than those in the control group(P<0.05).Before treatment,there was no significant difference being found in the comparison of scores of Lysholm and WOMAC,and ROM of knee joint between the two groups(P>0.05).After treatment,the Lysholm scores in the two groups were increased(P<0.05),WOMAC scores were decreased(P<0.05),and ROM was enlarged(P<0.05);the Lysholm score in the observation group was higher than that in the control group(P<0.05),WOMAC score was lower than that in the control group(P<0.05),and ROM was larger than that in the control group(P<0.05).Before treatment,there was no significant difference being found in the comparison of classification of fluid content between the two groups(P>0.05).After treatment,the numbers of cases with GradeⅠfluid content in the two groups were increased(P<0.05),and the numbers of cases with GradeⅢandⅣwere decreased(P<0.05),and the difference between the two groups was statistically significant(P<0.05).Before treatment,there was no significant difference being found in the comparison of levels of IL-6,MMP-3 and TIMP-1 in serum between the two groups(P>0.05).After treatment,the levels of IL-6 and MMP-3 in serum in the two groups were decreased(P<0.05),and TIMP-1 levels were increased(P<0.05);the levels of IL-6 and MMP-3 in serum in the observation group were lower than those in the control group,and TIMP-1 level was higher than that in the control group(P<0.05).There was no adverse reactions in the two groups during treatment.Conclusion:Micro acupotomy combined with warming-needle moxibustion has a significant effect in treating KOA patients,which can improve clinical symptoms,knee joint function,and ROM of knee joint,reduce body inflammatory reaction,and delay chondrocyte degeneration,with certain safety.