膝关节镜清理术联合中药离子导入治疗膝骨性关节炎的临床研究  

Clinical Study of Arthroscopic Debridement Combined with Chinese Medicine Iontophoresis in the Treatment of Knee Osteoarthritis

作　　者：李萌 贾叙锋[2] 周玉[2] 李彬[2] 张方德[2] 李军[2] 

机构地区：[1]成都市双流区中医医院骨科,成都610212 [2]简阳市人民医院骨科

出　　处：《中国中医骨伤科杂志》2017年第3期25-28,32,共5页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:探讨膝关节镜清理术联合中药离子导入治疗膝骨性关节炎的疗效及作用机制。方法:选取在2013年1月至2015年3月收治的60例膝骨性关节炎患者,按照治疗方式将患者随机分成两组,对照组(30例)予以膝关节镜清理术治疗,观察组(30例)予以膝关节镜清理术联合中药离子导入治疗。采用VSA疼痛评分及Lysholm膝关节功能评分标准,评定患者的临床治疗疗效及止痛效果;采用酶联免疫吸附法检测两组患者术前、术后关节液中金属基质蛋白酶-13(MMP-13)及白介素-1(IL-1)、肿瘤坏死因子-ɑ(TNF-ɑ)、转化生长因子-β(TGF-β)表达情况。结果:两组患者在治疗1个月后VSA疼痛评分比较差异无统计学意义(P>0.05),治疗6个月及12个月后观察组患者VSA疼痛评分明显低于对照组,差异有统计学意义(P<0.05);治疗后每个阶段观察组患者Lsholm膝关节功能评分均高于对照组,差异有统计学意义(P<0.05);两组患者治疗前、后MMP-13蛋白表达水平差异无统计学意义(P>0.05);两组患者在治疗前IL-1、TNF-ɑ表达水平比较差异无统计学意义(P>0.05),治疗后两组患者IL-1及TNF-ɑ表达水平均下降,但观察组IL-1及TNF-ɑ下降程度高于对照组,差异有统计学意义(P<0.05),观察组治疗前后组间比较均差异有统计学意义(P<0.05);治疗前TGF-β表达水平比较差异无统计学意义(P>0.05),治疗后两组患者TGF-β表达水平均上升,观察组患者上升程度高于对照组,差异有统计学意义(P<0.05),两组患者组间比较均差异有统计学意义(P<0.05)。结论:膝关节镜清理术联合中药离子导入治疗止痛效果明显优于单用膝关节镜清理术,并且联合治疗能快速调节患者体内炎症因子失衡情况,促进细胞正常增值与分化。Objective：To investigate the effect and mechanism of arthroscopic debridement combined with traditional Chi- nese medicine iontophoresis in the treatment of knee osteoarthritis. Methods： 60 cases with knee osteoarthritis in our hos- pital from January 2013 to March 2015 were randomly divided into control group and observation group, 30 cases in each group. The control group was treated with arthroscopic debridement, while the observation group was treated with arthro- scopic debridement combined with traditional Chinese medicine iontophoresis. VSA score and Lysholm knee function score were used to evaluate the clinic and analgesic effect. The expression of MMP13, IL-I, TNF-a and TGF-~ in synovial fluid of two groups were detected before and after surgery. Results： After 1 month of treatment, the VSA score of two groups had no significant difference （P〉0.05）, and the VSA score of the observation group was significantly lower than that of the control group （P〈0.05） after treatment for 6 months and 12 months. Lsholm knee function score of the observation group was higher than that in the control group at every stage after treatment （P〈0.05）. There was no difference in the expression of MMP13 protein between the two groups before and after treatment （P 〉 0. 05）. There was no difference before treatment in the expression of IL-1 and TNF-a protein between the two groups （P〉0.05）; IL-1, TNF-a expression level were decreased after treatment in two groups, but it decreased more in the observation group （P〈0.05）, and there was difference before and after treatment in two groups （P 〈0.05）. The expression level of TGF-β between two groups had no significant difference before treatment （P〈0.05）, and it increased in the two groups after treatment; the rise of the observation group was higher than that of the control group （P〈0.05） . Conclusion.. Arthroscopie debridement combined with traditional Chinese medicine iontophoresis is bet- ter than the single use of arthro

关 键 词：膝关节镜清理术 中药离子 膝骨性关节炎 疗效 作用机制 

分 类 号：R684.3[医药卫生—骨科学]