针药并用治疗膝骨关节炎的疗效观察及对疼痛和关节功能的影响

Clinical efficacy observation of acupuncture combined with Chinese medication on knee osteoarthritis and its influence on pain and joint function

目的观察针刺四关穴和郄穴联合蠲痹汤治疗膝骨关节炎的临床疗效及对患者关节疼痛和关节功能的影响。方法选取100例膝骨关节炎患者,随机分为对照组(50例)和观察组(50例)。对照组予口服蠲痹汤治疗,观察组在对照组治疗基础上联合针刺四关穴和郄穴治疗。比较两组临床疗效,比较两组治疗前后疼痛视觉模拟量表(visual analog scale,VAS)评分、西安大略与麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)评分和美国特种外科医院关节功能(Hospital for Special Surgery,HSS)评分,观察两组治疗前后骨代谢指标[血清骨钙素(osteocalcin,OC)和破骨细胞抑制因子(osteoclastogenesis inhibitory factor,OPG)]和炎症因子指标[血清白介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和白介素-1(interleukin-1,IL-1)]的变化。结果观察组总有效率为94.0%,高于对照组的72.0%(P<0.05)。治疗后,两组VAS评分和WOMAC总分以及血清IL-6、TNF-α和IL-1水平均较治疗前降低(P<0.05),且观察组低于对照组(P<0.05);两组HSS评分以及血清OC和OPG水平均较治疗前升高(P<0.05),且观察组高于对照组(P<0.05)。结论针刺四关穴和郄穴联合蠲痹汤治疗膝骨关节炎可有效减轻患者膝关节疼痛,改善膝关节功能及骨代谢水平,降低炎症因子水平,疗效优于单一中药治疗。

Objective To observe the clinical effect of acupuncture at Siguan points and Xi-cleft points combined with Juan Bi Tang in the treatment of knee osteoarthritis and its influence on joint pain and joint function.Method A total of 100 patients with knee osteoarthritis were randomly divided into a control group(50 cases)and an observation group(50 cases).The control group was treated with Juan Bi Tang,and the observation group was treated with acupuncture at Siguan points and Xi-cleft points on the basis of the treatment of the control group.The clinical efficacy was compared between the two groups.The pain visual analog scale(VAS)score,Western Ontario and McMaster Universities osteoarthritis index(WOMAC)score and American Hospital for Special Surgery(HSS)score before and after treatment were compared between the two groups.The bone metabolism indexes[serum osteocalcin(OC)and osteoclastogenesis inhibitory factor(OPG)]and inflammatory factor indexes[serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and interleukin-1(IL-1)]were observed before and after treatment in the two groups.Result The total effective rate of the observation group was 94.0%,which was higher than 72.0%of the control group(P<0.05).After treatment,the VAS scores,WOMAC total scores and levels of serum IL-6,TNF-α and IL-1 were lower than those before treatment in the two groups(P<0.05),and the scores and levels were lower in the observation group than those in the control group(P<0.05).Compared before treatment,the HSS scores and serum levels of OC and OPG were increased in the two groups(P<0.05),and the scores and levels were higher in the observation group than those in the control group(P<0.05).Conclusion Acupuncture at Siguan points and Xi-cleft points combined with Juan Bi Tang in the treatment of knee osteoarthritis can effectively reduce knee pain,improve knee joint function and bone metabolism,and reduce inflammatory factors.The curative effect is better than Chinese medication alone.