清瘀止痛方结合改良火针刺骨法治疗膝关节炎效果研究

Clinical Efficacy of Qingyu Zhitong Decoction(清瘀止痛方)Combined with Modified Pricking with Fire-Needle Therapy in Treatment of Knee Arthritis

目的 探究清瘀止痛方结合改良火针刺骨法治疗膝关节炎效果研究。方法 选取该院2019年1月—2022年1月骨科门诊收治的103例膝关节炎患者为研究对象,根据治疗方法不同分为针刺组33例、中药组34例与联合组36例。观察治疗前与治疗30 d后3组骨关节炎指数评分(WOMAC)、血清中的相关细胞因子[白细胞介素-6(IL-6)、基质金属蛋白酶-3(MMP-3)、肿瘤坏死因子-α(TNF-α)]、中医症状评分以及奎森功能演算指数(Lequesne)方面的评分。观察3组患者临床疗效与不良反应。结果 3组患者治疗前中医证候评分差异无统计学意义(P>0.05)。治疗30 d后3组患者中医证候积显著低于治疗前(P<0.05)。治疗30 d后联合组中医证候评分显著低于针刺组与中药组(P<0.05)。3组患者治疗前WOMAC、Lequesne评分差异无统计学意义(P>0.05)。治疗30 d后3组WOMAC、Lequesne评分较治疗前显著降低(P<0.05)。治疗30 d后联合组WOMAC、Lequesne评分显著低于针刺组与中药组(P<0.05)。3组患者治疗前TNF-α、MMP-3和IL-6浓度水平对比差异无统计学意义(P>0.05)。治疗30 d后3组TNF-α、MMP-3和IL-6水平显著低于治疗前(P<0.05)。治疗30 d后联合组TNF-α、MMP-3和IL-6水平显著低于针刺组与中药组(P<0.05)。治疗30 d后联合组总有效率为94.46%(34/36)显著高于针刺组63.63%(21/33)和中药组67.65%(21/34)(P<0.05)。针刺组不良反应发生率为9.09%(3/33)略高于联合组8.34%(3/36)与中药组5.88%(2/34),但3组患者不良反应发生率差异无统计学意义(P>0.05)。结论 清瘀止痛方结合改良火针刺骨法能有效提高患者临床疗效、改善膝关节的功能、降低炎症因子的浓度水平,达到抗炎镇痛的效果,值得在临床推广。

Objective To considered the clinical efficacy of Qingyu Zhitong Decoction(清瘀止痛方)combined with modified pricking with fire-needle therapy in the treatment of knee arthritis.Methods One hundred and three patients with knee arthritis in Orthopaedics Department of the hospital from January 2019 to January 2022 were enrolled,and the patients were classified into acupuncture group(33 cases),TCM group(34 cases)and combination therapy group(36 cases)according to different treatment methods.The Osteoarthritis index score(WOMAC),related cytokines in serum[tumor necrosis factor-α(TNF-α),matrix metalloproteinase-3(MMP-3),interleukin-6(IL-6)],Lequesne Algo-functional Index(Lequesne)and TCM symptom scores were observed before and 30 days after treatment.The adverse reactions and clinical efficacy of 3 groups were also recorded.Results TCM syndrome scores yielded no statistical difference among three groups(P>0.05).After 30 days of treatment,TCM syndrome scores showed a decrease in all three groups(P<0.05),and the combination therapy group had the lowest TCM syndrome score than the TCM group and acupuncture group(P<0.05).Serum levels of TNF-α,MMP-3 and IL-6 demonstrated no statistical difference among three groups before treatment(P>0.05),and the three inflammation indexes were decreased in all three groups after treatment(P<0.05),and the above indexes of the combination therapy group were lower than those of acupuncture group and TCM group(P<0.05).The total efficacy rate was 94.46%(34/36)in the combination therapy group,which was higher than 63.63%(21/33)in the acupuncture group and 67.65%(23/34)in the TCM group,with statistical difference(P<0.05).The adverse reaction rate was 8.34%(3/36)in the combination therapy group,which was slightly lower than 9.09%(3/33)in the acupuncture group and slightly higher than 5.88%(2/34)in the TCM group,with no statistical difference(P>0.05).Conclusion Qingyu Zhitong Decoction combined with modified pricking with fire-needle therapy in the treatment of knee arthritis can effectively improve the knee function,attenuate the inflammation response,achieve the effect of anti-inflammatory and analgesic,and is worthy of clinical promotion.