针刺结合艾灸及中药外敷治疗重度膝骨关节炎临床研究  

Clinical research of acupuncture moxibustion and traditional Chinese medicine external treatment of severe knee osteoarthritis

作　　者：师静[1] 冯媛媛[1] 张丽玲[1] 孙姗姗 罗亚萍[2] 

机构地区：[1]河北省石家庄市第一医院中西医结合科,050010 [2]河北省中医院风湿免疫科,石家庄050010

出　　处：《国际中医中药杂志》2018年第2期124-127,共4页International Journal of Traditional Chinese Medicine

基　　金：石家庄市科学技术与发展指导计划课题（111461123 ）

摘　　要：目的 评价针刺结合艾灸及中药外敷治疗重度膝骨关节炎的疗效。方法 将符合入选标准的重度膝骨关节炎患者86例，按随机数字法分为2组，每组43例。对照组于关节腔内注射玻璃酸钠，观察组在对照组基础上加用针刺结合艾灸及中药外敷治疗。2组均连续治疗5周，随访3个月。采用西大略湖麦克马斯特大学（Western Ontario McMaster Universities, WOMAC）评分系统评估膝关节结构及功能；采用VAS量表评估膝关节疼痛程度；采用Lysholm量表评价膝关节功能。采用ELISA法测定血清超敏C反应蛋白（hypersensitive C-reactive protein, hs-CRP）、IL-1、TNF-a，评价临床疗效。结果 观察组总有效率为93.0%（40/43）、对照组为76.7%（33/43），2组比较差异有统计学意义（χ2＝4.441，P＝0.035）。治疗后，观察组关节僵硬[（3.2±1.2）分比（4.8±2.1）分，t＝4.338]、关节疼痛[（4.2±1.3）分比（5.9±1.7）分，t＝4.903]、日常活动[（14.5±2.8）分比（18.7±2.9），t＝6.832]评分及WOMAC总分[（22.8±2.1）分比（29.2±2.7）分，t＝12.269]均低于对照组（P＜0.05）；观察组VAS评分[（2.5±0.8）分比（4.1±1.2）分，t＝7.275]低于对照组，Lysholm评分[（74.2±3.7）分比（67.4±3.9）分，t＝8.295]高于对照组（P＜0.05）；观察组血清hs-CRP[（8.34±2.24）mg/L比（13.67±2.54）mg/L，t＝10.321]、IL-1[（0.85±0.11）ng/L比（1.32±0.42）ng/L，t＝7.099]、TNF-a[（98.67±15.74）ng/L比（178.44±26.53）ng/L，t＝16.955]水平低于对照组（P＜0.05）。结论 针刺结合艾灸及中药外敷可有效改善重度膝骨关节炎患者膝关节功能，减轻疼痛症状。Objective To study the effect of moxibustion acupuncture and Chinese medicine external treatment for the severe knee osteoarthritis. Methods A total of 86 severe knee osteoarthritis patients were enrolled between December 2014 and December 2016, in Department of Integrated TCM ＆ Western Medicine, Shijiazhuang first hospital. According to the enrolled sequency, patients were divided into observation group and control group, 43 in each group. The control group was treated with intra-articular injection of sodium hyaluronate of 2ml, and the observation group was treated with the combined acupuncture moxibustion and traditional Chinese medicine external treatment on the basis of the control group. Two groups were performed for 3 months of follow-up. The clinical effect, WOMAC values, VAS score and Lysholm scale, and the serum high sensitivity C reactive protein （hs-CRP）, interleukin 1 （IL-1） and tumor necrosis factor a （TNF-a） changes before and after the treatment were observed and compared. Results The total effective rate of observation group was 93.0% （40/43）, while control group total effective rate was 76.7% （33/43）, and the differences between two groups was statistically significant （χ2=4.441, P=0.035）. After treatment, the WOMAC joint stiffness scores （3.2 ± 1.2 vs. 4.8 ± 2.1, t=4.338）, joint pain （4.2 ± 1.3 vs. 5.9 ± 1.7, t=4.903）, daily activities （14.5 ± 2.8 vs. 18.7 ± 2.9, t=6.832） in observation group were significantly lower than those in the control group. The VAS score （2.5 ± 0.8 vs. 4.1 ± 1.2, t=7.275） in observation group was significantly lower than the control group, while the Lysholm score （74.2 ± 3.7 vs. 67.4 ± 3.9, t=8.295） was significantly higher than the control group （P〈0.05）. The serum hs-CRP （8.34 ± 2.24 mg/L vs. 13.67 ± 2.54 mg/L, t=10.321）, IL-1 （0.85 ± 0.11 ng/L vs. 1.32 ± 0.42 ng/L, t=7.099）, TNF-a （98.67 ± 15.74 ng/L vs. 178.44 ± 26.53 ng/L, t=16.955） in the observation group patients were significantly

关 键 词：骨关节炎 膝 针剌 直接灸 热敷 炎性细胞因子 

分 类 号：R274.9[医药卫生—中西医结合]