水针刀疗法联合揉髌手法对膝骨关节炎患者疗效及即刻镇痛效应的影响  

Clinical Efficacy and Immediate Analgesic Effect of Water Acupotomy Combined with Patellar Kneading Manipulation in the Treatment of KOA

作　　者：王建华 李业 张雅静 WANG Jianhua;LI Ye;ZHANG Yajing(Nanjing Central Hospital, Nanjing 210018, China)

机构地区：[1]南京市中心医院,江苏南京210018

出　　处：《针灸临床杂志》2020年第3期15-19,共5页Journal of Clinical Acupuncture and Moxibustion

摘　　要：目的:探讨水针刀疗法联合揉髌手法对膝骨关节炎(KOA)患者临床疗效及即刻镇痛效应的影响。方法:选取2017年3月—2018年10月我院收治的124例KOA患者,应用简单随机数字表法将其随机分成观察组62例与对照组62例。观察组给予水针刀疗法联合揉髌手法治疗,对照组则予以膝关节腔内注射玻璃酸钠联合美洛昔康口服治疗,所有患者均治疗4周。比较两组临床疗效;每周治疗前后均利用视觉模拟评分法(VAS)对两组患者膝关节疼痛情况进行评估;并于治疗前后采用日本骨科协会(JOA)评估治疗分数评价患者患膝关节功能恢复状况,统计两组晨僵时间,且运用酶联免疫法测定相关软骨修复因子[转化生长因子(TGF-β)、成纤维细胞生长因子(FGF-2)、胰岛素样生长因子(IGF-1)]血清水平;同时记录两组不良事件发生情况。结果:观察组总有效率与对照组相比显著升高(P<0.05),两组每周治疗后膝关节疼痛VAS评分均较治疗前显著降低(P<0.05),且观察组膝关节疼痛VAS评分均显著低于对照组同时点(P<0.05)。两组治疗后JOA评分均较治疗前显著上升(P<0.05),晨僵时间则均显著缩短(P<0.05);且观察组JOA评分及晨僵时间改善优于对照组(P<0.05)。两组治疗后相关软骨修复因子(TGF-β、FGF-2、IGF-1)血清浓度均较治疗前显著升高(P<0.05),但观察组上升更显著(P<0.05)。结论:水针刀疗法联合揉髌手法治疗KOA能有效缓解患者膝关节疼痛程度,改善患膝关节功能,缩短晨僵时间,整体疗效确切,这可能与本联合疗法显著上调血中TGF-β、FGF-2、IGF-1表达有关;同时水针刀疗法联合揉髌手法的即刻镇痛效应佳。Objective:To explore the clinical efficacy and the immediate analgesic effect water acupotomy therapy combined with patellar kneading manipulation in the treatment of knee osteoarthritis(KOA).Methods:124 cases of KOA were randomly divided into the observation group(n=62)and the control group(n=62).The observation group was treated with water acupotomy combined with patellar kneading manipulation,whereas the control group was treated with intra-articular injection of sodium hyaluronate combined with oral Meloxicam.After four weeks of treatment,the clinical efficacy was compared between the two groups.The pain of knee joints was evaluated by the scores of visual analogue scale(VAS)and the recovery of knee joint function was assessed by the scores of Japanese Orthopaedic Association(JOA)before and after the treatment every week.The duration of morning stiffness was counted,and serum levels of related cartilage repair factors,such as transforming growth factor(TGF-β),fibroblast growth factor(FGF-2)and insulin-like growth factor(IGF-1),were measured by euzymelinked immunosorbent assay.The occurrence of adverse events was recorded in both groups.Results:The total effective rate of the observation group was significantly higher than that of the control group(P<0.05).The VAS scores of knee pain in both groups were significantly lower after weekly treatment than those before the treatment(P<0.05);the VAS scores in the observation group were significantly lower than those in the control group at the same time point(P<0.05).The JOA scores in both groups were increased significantly(P<0.05),and the time of morning stiffness was shortened significantly(P<0.05);of which the improvements were more significant in the observation group(P<0.05).The serum levels of TGF-β,FGF-2 and IGF-1 were significantly increased after the treatment than those before the treatment in the two groups(P<0.05);the increases in the observation group were more significant(P<0.05).No significant adverse effects were observed in the two groups.Conclusi

关 键 词：水针刀疗法 揉髌手法 膝骨关节炎 即刻镇痛效应 软骨修复因子 

分 类 号：R246.2[医药卫生—针灸推拿学]