基于定量MRI及定量CT评估消增强骨片结合郑氏舒活酊治疗膝骨关节炎合并骨质疏松症的价值研究

Study on the value of Xiaozeng Qianggu tablet combined with Zhengshishuhuo tincture in treating knee osteoarthritis combined with osteoporosis:an assessment based on quantitative MRI and QCT

目的:基于定量磁共振成像(MRI)和定量CT(QCT),评估消增强骨片结合郑氏舒活酊治疗膝骨关节炎(KOA)合并骨质疏松(OP)的价值。方法:选取医院收治的80例KOA合并OP患者,按照随机数表法分为观察组和对照组,每组40例。观察组使用消增强骨片结合郑氏舒活酊配局部按摩的方式治疗,对照组单用郑氏舒活酊配局部按摩的方式治疗。比较治疗前后两组患者疼痛视觉模拟量表(VAS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)及生活质量评价简式-36(SF-36)量表评分,以及患者血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平变化,采用定量MRI和QCT测量患者膝关节治疗前后影像学变化,比较两组患者治疗前后膝关节全器官磁共振评分WORMS及骨密度(BMD)值。结果:治疗后,观察组患者的VAS及WOMAC评分低于对照组,SF-36评分高于对照组,差异有统计学意义(t=2.518,t=2.017,t=2.262;P<0.05);观察组血清TNF-α、IL-1β及IL-6水平均低于对照组,差异有统计学意义(t=2.429,t=2.641,t=4.065;P<0.05);观察组软骨下骨髓水肿、半月板损伤及变性与关节积液评分低于对照组,差异有统计学意义(t=2.641,t=2.216,t=2.262;P<0.05);观察组患者股骨内髁、股骨外髁、胫骨外侧平台及胫骨内侧平台4个部位的BMD值均高于对照组,差异有统计学意义(t=2.864,t=3.985,t=4.276,t=2.714;P<0.05)。结论:消增强骨片结合郑氏舒活酊配局合部按摩可有效减轻KOA合并OP患者的疼痛,改善关节功能,延缓膝关节OP。

Objective:To assess the value of Xiaozeng Qianggu tablet combined with Zhengshishuhuo tincture in treating knee osteoarthritis(KOA)combined with osteoporosis(OP)on the basis of quantitative magnetic resonance imaging(MRI)and quantitative CT(QCT).Methods:A total of 80 patients with KOA combined with OP admitted to the hospital were selected,and they were divided into an observation group and a control group according to the random number table method,with 40 cases in each group.The observation group was treated with Xiaozeng Qianggu Tablets combined with Zhengshishuhuo tincture that coordinated local massage,while the control group was treated with Zhengshishuhuo tincture alone coordinated local massage.The visual analogue scale(VAS),Westerm Ontario and Mcmaster Universities Osteoarthritis Index(WOMAC)and short form-36(SF-36)scores before and after treatment of the two groups of patients were compared,as well as the changes of serum IL-1β,IL-6 and TNF-αlevels of patients.Quantitative MRI and QCT were used to measure the imaging changes of the patients'knee joints before and after treatment,and whole organ magnetic resonance imaging score(WOMRIS)and bone mineral density(BMD)values of knee joint before and after treatment between two groups were further compared.Results:After treatment,the VAS and WOMAC scores of the patients in the observation group were significantly lower than those of the control group,and the SF-36 scores of that was significantly lower than that of the control group,the differences were statistically significant(t=2.518,t=2.017,t=2.262,P<0.05),respectively.The serum TNF-α,IL-1β,and IL-6 levels of the observation group were significantly lower than those in the control group,and the differences were statistically significant(t=2.429,t=2.641,t=4.065,P<0.05).The scores of subchondral bone marrow edema,meniscal injury and degeneration and joint effusion of observation group were significantly lower than those of the control group,and the differences were statistically significant(t=2.641,t=2.216,t=2.262,P<0.05).The BMD values of the four parts included the femoral medial condyle,lateral condyle,tibial lateral platform and tibial medical platform of the observation group were respectively higher than those of control group,and the differences were statistically significant(t=2.864,t=3.985,t=4.276,t=2.714,P<0.05).Conclusion:Xiaozeng Qianggu Tablets combined with Zhengshishuhuo tincture that coordinated local massage can effectively relieve pain of patients with KOA combined with OP,and improve joint function,and delay osteoporosis of knee joint.