中医药防治膝骨关节炎肿胀作用机制

Effect and Mechanism of Traditional Chinese Medicine in Preventing and Treating Knee Osteoarthritis Swelling

膝骨关节炎(knee osteoarthritis,KOA)是中老年人群常见的慢性退行性骨关节疾患,多以关节疼痛、活动受限为主要症状,常伴有关节肿胀、畸形等。膝关节肿胀限制关节活动,加重疼痛,影响患者的生活质量及身心健康。KOA肿胀原因总结为软骨与滑膜炎症、血管微循环异常、淋巴循环障碍、膝关节力学平衡失稳等。西医保守治疗主要是非甾体类抗炎药内服外用,关节灌注糖皮质激素治疗,然而患者易反复出现症状。中医药发展历史悠久,疗法多样,文献研究发现针灸、推拿、中药内服外用均有减轻KOA肿胀的效果,总结其治疗机制为降低炎症水平、促进循环代谢、抑制细胞外基质降解、调控软骨细胞增殖与凋亡等方面。该文将从KOA肿胀原因、现代医学消肿疗法、中医药消肿机制及主要调控通路进行综述,并总结目前研究热点,探讨未来研究方向。

Knee osteoarthritis(KOA)is a common chronic degenerative bone and joint disease in middle-aged and elderly people.The main symptoms are joint pain and limited activity,often accompanied by joint swelling and deformity.Knee swelling limits joint activity,aggravates pain,and affects the quality of life and physical and mental health of patients.The causes of KOA swelling are summarized as cartilage and synovial inflammation,abnormal vascular microcirculation,lymphatic circulation disorder,and instability of knee joint mechanical balance.Western medicine conservative treatment is mainly non-steroidal anti-inflammatory drugs for oral and external use,joint perfusion of glucocorticoid treatment,symptoms are easy to repeat.The causes of KOA swelling are summarized as cartilage and synovial inflammation,abnormal vascular microcirculation,lymphatic circulation disorder,and instability of knee joint mechanical balance.The conservative treatment of Western medicine is mainly non-steroidal anti-inflammatory drugs for oral and external use,and joint perfusion of glucocorticoids.However,patients are prone to recurrent symptoms.Traditional Chinese medicine has a long history of development and various therapies.Literature studies have found that acupuncture,massage,oral and external use of traditional Chinese medicine have the effect of reducing KOA swelling.The therapeutic mechanism is to reduce the level of inflammation,promote circulatory metabolism,inhibit the degradation of extracellular matrix,and regulate the proliferation and apoptosis of chondrocytes.This article will review the causes of KOA swelling,modern medical detumescence therapy,traditional Chinese medicine detumescence mechanism and main regulatory pathways,summarize the current research hotspots,and explore future research directions.