经验方健步汤局部熏洗联合穴位热敷治疗寒湿痹阻型膝骨关节炎患者临床疗效及安全性观察

Clinical Efficacy and Safety of Jianbu Decoction for Local Fumigation Combined with Acupoint Hot Compress in Treatment of Knee Osteoarthritis with Cold-dampness Obstruction Syndrome

目的评价经验方健步汤局部熏洗联合穴位热敷治疗寒湿痹阻型膝骨关节炎患者的临床疗效及安全性。方法选取2021年1月—2022年12月期间于北京中医药大学第三附属医院创伤关节科门诊就诊的寒湿痹阻型膝关节炎患者72例,采用随机数字表法分为对照组和治疗组,每组各36例。对照组采用双氯芬酸钠二乙胺乳胶剂行膝关节局部痛点及特定穴位外抹,治疗组采用健步汤行膝关节局部熏洗加特定穴位热敷,两组患者在接受药物治疗的同时均进行股四头肌功能锻炼。治疗2周后,观察比较两组患者中医疗效,治疗前后视觉模拟评分(Visual analogue scale,VAS)、膝关节炎评分量表(The western ontario mcmaster university,WOMAC)评分、膝关节滑膜厚度及关节积液深度改变。结果治疗后两组患者VAS评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组VAS评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者WOMAC评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组WOMAC评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者髌上囊滑膜厚度均较治疗前减少,差异有统计学意义(P<0.05);且治疗组髌上囊滑膜厚度减少明显优于对照组,差异有统计学意义(P<0.05)。治疗后两组患者髌上囊积液深度均较治疗前降低,差异有统计学意义(P<0.05);且治疗组髌上囊积液深度明显低于对照组,差异有统计学意义(P<0.05)。治疗后治疗组临床有效率91.67%(33/36)明显高于对照组72.22%(26/36),差异有统计学意义(P<0.05)。结论经验方健步汤熏洗配合穴位热敷可有效减轻寒湿痹阻型膝骨关节炎患者临床症状并改善关节功能,值得临床推广应用。

Objective To evaluate the clinical efficacy and safety of Jianbu Decoction for local fumigation combined with acupoint hot compress in the treatment of knee osteoarthritis(KOA)with cold-dampness obstruction syndrome.Methods Seventy-two KOA patients with cold-dampness obstruction syndrome who visited the Department of Trauma Arthropathy at the Beijing University of Chinese Medicine Third Affiliated Hospital between January 2021 and December 2022 were selected and randomly divided into a control group and a treatment group using a random number table,with 36 cases in each group.The control group was treated with diclofenac sodium diethylamine emulgel applied to local painful points and specific acupoints,while the treatment group received Jianbu Decoction for local fumigation combined with acupoint hot compress.Both groups also performed quadriceps strengthening exercises during the treatment.After two weeks of treatment,the groups were compared in terms of traditional Chinese medicine(TCM)efficacy,visual analogue scale(VAS)scores,Western Ontario McMaster University Osteoarthritis Index(WOMAC)scores,knee synovial membrane thickness,and depth of joint effusion before and after treatment.Results After treatment,the VAS scores of both groups were significantly reduced compared to baseline(P<0.05),with the treatment group showing significantly lower scores than the control group(P<0.05).The WOMAC scores of both groups also decreased significantly compared to baseline(P<0.05),and the treatment group had significantly lower WOMAC scores than the control group(P<0.05).Both groups exhibited a significant reduction in synovial membrane thickness in the suprapatellar bursa compared to baseline(P<0.05),with the treatment group showing significantly greater reduction than the control group(P<0.05).The depth of joint effusion in the suprapatellar bursa also significantly decreased in both groups compared to baseline(P<0.05),with the treatment group showing significantly lower values than the control group(P<0.05).The clinical effective rate in the treatment group was 91.67%(33/36),significantly higher than 72.22%(26/36)in the control group(P<0.05).Conclusion Jianbu Decoction fumigation combined with acupoint hot compress effectively alleviates the clinical symptoms of cold-dampness obstruction-type KOA and improves joint function,making it worthy of clinical promotion and application.