关节镜联合阿西美辛、尪痹胶囊治疗老年膝骨性关节炎的疗效分析

Effect of Arthroscopy Combined with Acemetacin and Wangbi Capsule(尪痹胶囊)in Treatment of Elderly KOA

目的观察关节镜清理联合阿西美辛加尪痹胶囊治疗老年膝骨性关节炎(knee osteoarthritis,KOA)疗效及对患者骨代谢指标和滑膜液中炎性因子的影响。方法2018年12月—2021年12月该院收治的106例老年肝肾亏虚证KOA患者以随机数字表及随机余数分组法分为联合组和对照组各53例。联合组给予关节镜清理,术后联合使用阿西美辛+尪痹胶囊治疗,对照组给予关节镜清理,术后联合使用阿西美辛治疗。比较两组临床疗效,记录治疗前、治疗2个月后两组病情严重程度[Lequesne膝关节严重程度指数(ISOA)]、膝关节超声指标(滑膜厚度、髌上囊积液)、骨代谢指标[骨钙素(BGP)、骨保护素(OPG)、寡聚基质蛋白(COMP)]、关节滑膜液中炎性因子[白细胞介素17(IL-17)、肿瘤坏死因子(TNF-α)、脂联素(APN)、前列腺素(PGE-2)]水平差异。结果联合组临床总有效率为96.23%(51/53),高于对照组的84.91%(45/53)(P<0.05)。治疗2个月后,两组Lequesne评分、关节超声指标(滑膜厚度、髌上囊积液厚度)、关节滑液中炎性因子水平(IL-17、TNF-α、APN、PGE-2)、血清COMP水平均较治疗前明显降低,且联合组低于对照组,差异有统计学意义(P<0.05);两组血清骨代谢指标(BGP、OPG)较治疗前明显升高,且联合组高于对照组(P<0.05)。结论关节镜清理联合阿西美辛+尪痹胶囊治疗老年KOA疗效显著,能有效改善患者临床症状,降低炎性反应,改善骨代谢状态。

Objective To observe the effect of arthroscopic debridement combined with acemetacin and Wangbi Capsule(尪痹胶囊)in the treatment of elderly knee osteoarthritis(KOA)and its effects on bone metabolism indicators and inflammatory factors in synovial fluid.Methods A total of 106 elderly patients with KOA of liver-kidney deficiency syndrome admitted to the hospital between December 2018 and December 2021 were divided into the combined group and the control group with 53 cases in each group according to the random number table method and random remainder grouping method.The combined group was given arthroscopic debridement,and then combined with acemetacin and Wangbi Capsule after surgery,while the control group was treated with arthroscopic debridement and acemetacin.The clinical efficacy of the two groups was compared,and the disease severity[Lequesne Severity Index of Osteoarthritis(ISOA)],knee ultrasound indicators[synovial thickness,suprapatellar bursa effusion],bone metabolism indicators[bone gla protein(BGP),osteoprotegerin(OPG),cartilage oligomeric matrix protein(COMP)]and inflammatory factors in synovial fluid[interleukin 17(IL-17),tumor necrosis factor(TNF-α),adiponectin(APN),prostaglandin(PGE-2)]were recorded before treatment and after 2 months of treatment.Results The total clinical effective rate of the combined group was 96.23%(51/53),which was higher than 84.91%(45/53)of the control group(P<0.05).After 2 months of treatment,the Lequesne score,joint ultrasound indicators(synovial thickness,suprapatellar bursa effusion thickness),the levels of synovial fluid inflammatory factors(IL-17,TNF-α,APN,PGE-2)and level of serum COMP were significantly reduced in the two groups compared with those before treatment,and the above indicators in the combined group were lower than those of the control group(P<0.05).Serum bone metabolism indicators(BGP,OPG)in the two groups were significantly enhanced compared with those before treatment,and the indicators were higher in the combined group compared with those in the control group(P<0.05).Conclusion Arthroscopic debridement combined with acemetacin and Wangbi Capsule is significantly effective in the treatment of elderly KOA,and it can effectively improve the clinical symptoms,reduce the inflammatory response and improve the bone metabolism status.