调髓补中法辅助治疗膝骨关节炎的临床观察  

Clinical Observation of Tiaosui Buzhong Method(Invigorating Bone Marrow and Supplementing Wei-qi)Assisted Treatment for Knee Osteoarthritis

作　　者：范梦强 吕帅洁[2] 金红婷[2] 童培建[2] FAN Meng-qiang;LU Shuai-jie;JIN Hongting;TONG Pei-jian(First Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou,310053;Department of Traumatic Orthopaedics,First Affiliated Hospital,Zhejiang Chinese Medical University,Hangzhou,310006)

机构地区：[1]浙江中医药大学第一临床医学院,杭州310053 [2]浙江中医药大学附属第一医院骨伤中心,杭州310006

出　　处：《中国中西医结合杂志》2021年第7期784-789,共6页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：浙江省中医药科技计划项目(No.2021ZZ014)。

摘　　要：目的评估具有调髓补中作用的骨健口服液辅助治疗膝骨关节炎(KOA)的临床疗效。方法100例均为2016年5月—2019年3月浙江省中医院KOA患者,Kellgren-Lawrence分级1~3级。根据治疗方式不同分为对照组50例(口服西乐葆2周+硫酸氨基葡萄糖6周)、试验组50例(口服西乐葆2周+硫酸氨基葡萄糖6周+骨健口服液6周)。采用视觉模拟评分(VAS)、西安大略和麦克马斯特大学(WOMAC)骨关节炎指数、软骨损伤评分系统(CaLs)、全膝关节核磁共振成像积分(WORMS)、双(多)能X线评估治疗前及治疗后6周及3、6、12个月的临床表现、关节损伤影像学表现及骨量情况。结果所有患者均完成12个月随访。治疗及随访期间未见不良反应。与本组治疗前比较,试验组治疗后6周及3、6、12个月VAS及WOMAC评分均较治疗前下降(P<0.05);对照组治疗后6周及3、6个月VAS评分及治疗后6周及3个月WOMAC评分亦下降(P<0.05);与对照组同期比较,试验组VAS、WOMAC评分下降幅度更大(P<0.05,P<0.01)。两组治疗前及治疗后6个月CaLs深度及形态评分比较,差异均无统计学意义(P>0.05)。试验组3例患者治疗后膝关节MRI提示有软骨修复。试验组治疗后6个月骨密度(T值)较治疗前及对照组同期更小(P<0.05,P<0.01)。试验组出现骨髓水肿21例,对照组24例,两组均未作特殊处理,试验组治疗后6个月骨髓水肿评分(WORMS评分)较治疗前及对照组同期下降(P<0.05)。结论常规西药治疗基础上加服有调髓补中作用的骨健口服液,可有效改善早中期KOA患者临床症状,延缓患者膝关节软骨的破坏,一定程度促进软骨再生及骨髓水肿的吸收,提高患者骨量。Objective To evaluate the clinical effect of Gujian Oral Liquid[GOL,with the actions of Tiaosui Buzhong(invigorating bone marrow and supplementing Wei-qi)]in the adjuvant treatment of knee osteoarthritis(KOA).Methods A total of 100 KOA patients were recruited from Zhejiang Provincial Hospital of TCM,May 2016 to March 2019.They were graded as 1-3 by Kellgren-Lawrence grading.According to different treatment methods,they were assigned to a control group(50 cases,Celebrex for 2 weeks+Glucosamine Sulfate for 6 weeks)and an experimental group(50 cases,Celebax for 2 weeks+Glucosamine Sulfate for 6 weeks+GOL for 6 weeks).Visual analogue scale(VAS),Western Ontario and McMaster University(WOMAC),cartilage lesion score(CaLs),whole-organ magnetic resonance imaging score(WORMS)and dual-(multiplex)X-ray were used to evaluate the clinical manifestations,imaging manifestations of joint injury,and bone mass before treatment and at 6 weeks after treatment,at 3,6,and 12 months after treatment.Results All patients were followed-up for 12 months.No adverse reactions were observed during treatment and follow-up.Compared with the same group before treatment,VAS and WOMAC scores of the experimental group were lower after treatment,at week 6 after treatment,and at month 3,6,and 12 after treatment(P<0.05).The decrease in VAS and WOMAC was more in the control group(P<0.05,P<0.01).There was no significant difference in the depth and morphological scores of CaLs between the two groups before treatment and at month 6 after treatment(P>0.05).MRI of the knee joint after treatment indicated that the cartilage was repaired in 3 patients of the experimental group.The bone mineral density(T value)of the experimental group at month 6 after treatment was lower than that before treatment and the same time point in the control group(P<0.05,P<0.01).Bone marrow edema occurred in 21 cases in the experimental group and 24 cases in the control group.No special treatment was given to both groups.The bone marrow edema score(WORMS score)of the experimental gr

关 键 词：调髓补中法 骨健口服液 膝骨关节炎 软骨 骨髓水肿 

分 类 号：R684.3[医药卫生—骨科学]