小针刀结合手法松解治疗膝关节骨性关节炎效果观察

Effect Observation of Small Acupotomy Combined with Manual Release in Treatment of Knee Osteoarthritis

目的评价小针刀结合手法松解对膝关节骨性关节炎患者的炎症因子及关节功能的影响。方法选择2020年3月—2021年3月在汕头市第二人民医院中医骨伤科实施治疗的80例膝关节骨性关节炎患者为此次试验的对象,随机分为两组各40例。治疗组给与小针刀和手法松解治疗,观察组采用小针刀治疗。比较两组疼痛症状评分、西安大略和麦克马斯特大学骨关节指数(Western Ontario and McMaster University Osteoarthritis Index,WOMAC)和国际骨关节炎评分(International Osteoarthritis Scoring Standards,Lequesne);比较两组患者治疗前后血清抗酒石酸盐酸性磷酸酶异构体(anti-tartrate acid phosphatase isomer-5b,TRACP-5b)、骨钙素(bone gla protein,BGP)、前列腺素E2(prostaglandin E2,PGE2)含量变化,比较治疗疗效,比较不良反应发生率。结果治疗组中有17例(42.50%)达到显效标准,有20例(50.00%)达到好转标准;对照组中达到显效标准的有11例(27.50%),达到好转标准的有19例(47.50%)(P<0.05);两组治疗后活动痛指数、静息痛指数、关节压痛指数和关节肿胀指数及Lequesne评分、WOMAC评分较治疗前降低,且治疗组降低幅度优于对照组(P<0.05);两组治疗后骨代谢炎症因子BGP水平较治疗前升高,TRACP-5b和PGE2水平较治疗前降低。治疗组治疗后骨代谢炎症因子BGP水平高于对照组,TRACP-5b和PGE2水平低于对照组(P<0.05);不良反应发生概率方面,两组患者对比差异无统计学意义(P>0.05)。结论小针刀结合手法松解可有效改善膝关节骨性关节炎的疼痛、肿胀状态,扩大关节活动度,改善骨代谢炎症因子水平,提高治疗疗效,值得临床进一步研究探讨。

Objective To evaluate the effect of small acupotomy combined with manipulation release on inflammatory factors and joint function in patients with knee osteoarthritis.Methods In March 2020 to March 2021 in our hospital,80 cases of knee osteoarthritis treated with acupuncture were as the research objects.Based on the randomized controlled method,the patients were divided into two groups,40 cases in each group.The treatment group was given small acupotomy and manipulation release.The observation group was treated with small acupotomy.The symptom scores of pain,Western Ontario and McMaster University Osteoarthritis Index(WOMAC)and International osteoarthritis scoring standards(Lequesne)of two groups were compared.Before and after treatment,serum levels of anti-tartrate acid phosphatase isomer-5b(TRACP 5b),osteocalcin(BGP)and prostaglandin E2(PGE2)and the incidence of adverse reactions of two groups were compared.Results In the treatment group,17 cases(42.50%)reached the standard for significant improvement,and 20 cases(50.00%)reached the standard for improvement.In the control group,11 cases(27.50%)reached the standard for significant improvement,and 19 cases(47.50%)reached the standard for improvement(P<0.05).After treatment,the activity pain index,resting pain index,joint tenderness index,joint swelling index,Lequesne score and WOMAC score of the two groups decreased compared to those before treatment,and the reduction in the treatment group was better than that in the control group(P<0.05).After treatment,the levels of bone metabolism inflammatory factor BGP increased in both groups compared to those before treatment,while the levels of TRACP-5b and PGE2 decreased compared to those before treatment.After treatment,the levels of bone metabolism inflammatory factor BGP in the treatment group were higher than those in the control group,while the levels of TRACP-5b and PGE2 were lower than those in the control group(P<0.05).In terms of the probability of adverse reactions,there was no statistically significant difference between the two groups of patients(P>0.05).Conclusion The combination of small acupotomy and manipulation release can effectively improve the knee joint osteoarthritis pain and swelling state,expand joint activity,improve bone metabolism inflammatory factor levels and enhance the curative effect,worthy of further clinical research.