针刀治疗股骨头坏死的镇痛作用与神经递质关系的初步研究  

A Preliminary Study on Relationship between the Analgesic Effect of Needle-Knife for the Treatment of Osteonecrosis of the Femoral Head and Neurotransmitter

作　　者：李泰贤 颜炎 傅繁誉 王荣田 韦伟 林娜[2] 何海军[3] 陈卫衡 LI Taixian;YAN Yan;FU Fanyu;WANG Rongtian;WEI Wei;LIN Na;HE Haijun;CHEN Weiheng(The Third Affiliated Hospital of Beijing University of Chinese Mdicine,Beijing 10029,China;Instiute of Chinese Materia Medica,China Academy of Chinese Medical Sciences,Beijing 100700,China;Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China)

机构地区：[1]北京中医药大学第三附属医院,北京100029 [2]中国中医科学院中药研究所 [3]中国中医科学院望京医院

出　　处：《中国中医骨伤科杂志》2021年第3期12-16,共5页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：国家自然科学基金面上项目(81973888,81873322);“十二五”国家科技支撑计划项目(2015BAI04B03);北京市自然科学基金面上项目(7182186);中国博士后科学基金项目(2019M660954);中国中医科学院特色诊疗技术与方法研究项目(ZZ070864)。

摘　　要：目的:通过观察针刀疗法对缓解股骨头坏死疼痛的疗效和疼痛相关神经递质的影响,初步探索针刀疗法的镇痛机制。方法:收集2018年8月至2019年11月接受针刀治疗的26例股骨头坏死患者,通过疼痛视觉模拟(VAS)评分与髋关节总活动度评价临床疗效,采用酶联免疫吸附试验检测外周血速激肽(TK)、降钙素基因相关肽(CGRP)、5-羟色胺(5-HT)、P物质(SP)、缓激肽(BK)、神经肽Y(NPY)含量探索针刀疗法的镇痛机制。结果:针刀治疗后所有患者均未出现明显不良反应。针刀治疗后第1天与第7天两个观察时间点的VAS评分与髋关节总活动度较治疗前均有明显改善,差异有统计学意义(P<0.01)。针刀治疗后第7天的TK,CGRP,5-HT,SP、BK,NPY含量均低于治疗前,差异有统计学意义(P<0.05);针刀治疗后第1天的5-HT及SP含量低于治疗前,差异有统计学意义(P<0.05),TK,CGRP,BK,NPY含量与治疗前比较差异无统计学意义(P>0.05)。结论:针刀治疗股骨头坏死具有缓解疼痛与改善关节功能见效迅速、疗效显著、副作用少的优势,其镇痛机制可能是通过调节多个神经递质的失衡状态而实现的。Objective:To explore the analgesic mechanism of needle-knife by observing the effect of needle-knife on pain relief and its connected neurotransmitters of osteonecrosis of the femoral head.Methods:26 patients with osteonecrosis of the femoral head were recruited who received needle-knife therapy from August 2018 to November 2019.Visual analogue scales(VAS)and range of motion(ROM)of hip joints were recorded in different follow-up times to evaluate the clinical efficacy.The contents of Tachykinin(TK),Calcitonin gene related peptide(CGRP),5-Hydroxytrypta mine(5-HT),Substance P(SP),Bradykinin(BK)and Neuropeptide Y(NPY)were detected in peripheral blood with ELISA in different follow-up times to explore the analgesic mechanism.Results:No adverse effects and severe complications were observed after needle-knife treatment.The VAS and ROM at 1 and 7 d after needle-knife treatment were better than pre-treatment(P<0.05).Compared with pre-treatment,the contents of TK,CGRP,5-HT,SP,BK and NPY were lower at 7 d(P<0.01);the contents of 5-HT,SP were lower at 1 d after treatment than before(P<0.01);there was no significant differences in the contents of TK,CGRP,BK,NPY at 1 d before and after treatment(P>0.05).Conclusion:Needle-knife therapy for osteonecrosis of femoral head has the advantages of relieve pain and improve joint function quickly,without evident adverse reaction.Its analgesic mechanism of needle-knife on osteonecrosis of femoral head may through the adjusting of some neurotransmitters metabolism disequilibrium.

关 键 词：股骨头坏死 针刀 镇痛机制 神经递质 疗效 

分 类 号：R681.8[医药卫生—骨科学]