针刀疗法联合骨疏康颗粒对老年性膝骨关节炎患者关节液中炎症因子水平的影响  

Effects of Acupotomy Combined with Gushukang Granules on Levels of Inflammatory Factors in Synovial Fluid of Patients with Senile Knee Osteoarthritis

作　　者：方正中 孙奎 宋阳春 朱俊琛 FANG Zheng-Zhong;SUN Kui;SONG Yang-Chun;ZHU Jun-Chen(The Second Dept.of Orthopedics,the Second Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230061 Anhui,China;The First Dept.of Orthopedics,the Second Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230061 Anhui,China)

机构地区：[1]安徽中医药大学第二附属医院(安徽省针灸医院)骨二科,安徽合肥230061 [2]安徽中医药大学第二附属医院(安徽省针灸医院)骨一科,安徽合肥230061

出　　处：《广州中医药大学学报》2022年第3期556-562,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：安徽省科技厅科技计划项目(编号:1704a0802168)。

摘　　要：【目的】观察针刀疗法联合骨疏康颗粒治疗肝肾亏虚型老年性膝骨关节炎(KOA)患者的临床疗效以及对膝关节液中炎症因子水平的影响。【方法】将80例肝肾亏虚型老年性KOA患者随机分为试验组和对照组,每组各40例。试验组给予针刀疗法联合骨疏康颗粒口服治疗,对照组给予关节腔内注射玻璃酸钠治疗,疗程为4周。观察2组患者治疗前后膝关节疼痛视觉模拟量表(VAS)评分、膝关节活动度(ROM)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)以及膝关节液中白细胞介素6(IL-6)、白细胞介素1β(IL-1β)和肿瘤坏死因子α(TNF-α)水平的变化情况,并评价2种治疗方案的安全性。【结果】(1)随访期间,试验组和对照组分别有3例和4例患者脱落,最终试验组和对照组分别有37例和36例患者纳入统计分析。(2)治疗1周、4周后和12周随访时,2组患者的膝关节疼痛VAS评分均较治疗前明显降低(P<0.05),且治疗4周后2组患者的膝关节疼痛VAS评分均较治疗1周后明显降低(P<0.05),而12周随访时,观察组的膝关节疼痛VAS评分较治疗4周后无明显变化(P>0.05),对照组则有显著性增高(P<0.05);组间比较,试验组在各观察时点对膝关节疼痛VAS评分的降低作用均明显优于对照组(P<0.01)。(3)治疗1周和4周后,2组患者的膝关节ROM均较治疗前明显改善(P<0.05),且治疗4周后2组患者的膝关节ROM均较治疗1周后改善(P<0.05);组间比较,试验组在治疗1周和4周后对膝关节ROM的改善作用均明显优于对照组(P<0.01)。(4)治疗1周和4周后,2组患者的膝关节WOMAC评分均较治疗前明显降低(P<0.05),且治疗4周后2组患者的膝关节WOMAC评分均较治疗1周后明显降低(P<0.05);组间比较,试验组在治疗1周和4周后对膝关节WOMAC评分的降低作用均明显优于对照组(P<0.01)。(5)治疗4周后,2组患者的关节液IL-6、IL-1β、TNF-α水平均较治疗前明显降低(P<0.05),且试验组对关节液Objective To investigate the clinical efficacy of acupotomy combined with Gushukang Granules in treating senile knee osteoarthritis(KOA)with liver and kidney deficiency syndrome,and to observe their influence on inflammatory factors in knee synovial fluid.Methods Eighty senile KOA patients with liver and kidney deficiency were randomly divided into trial group and control group,with 40 cases in each group.The trial group was given acupotomy combined with oral administration of Gushukang Granules,while the control group was given intra-articular injection of sodium hyaluronate,and the course of treatment lasted for 4 weeks.The changes of knee pain visual analogue scale(VAS)scores,range of motion(ROM)of the knee,Western Ontario and McMaster University oosteoarthritis index(WOMAC)and the levels of interleukin 6(IL-6),interleukin 1β(IL-1β)and tumor necrosis factorα(TNF-α)in the synovial fluid of the two groups were observed before and after treatment,and the safety of the two treatment regimens was also evaluated.Results(1)During the follow-up period,3 patients in the trial group and 4 patients in the control group fell off,and finally 37 patients in the trial group and 36 patients in the control group were included in the statistical analysis.(2)After treatment for one week and for 4 weeks and at the 12 th week for follow-up,the knee pain VAS scores in both groups were significantly decreased compared with those before treatment(P<0.05).After 4 weeks of treatment,the knee VAS scores of patients in both groups were significantly decreased compared with those after one week of treatment(P<0.05).At the 12 th week for follow-up,the knee pain VAS scores in the observation group showed no significant changes in comparison with those after treatment for 4 weeks(P>0.05),but there was a significant increase of the scores shown in the control group(P<0.05).The intergroup comparison showed that the effect on lowering the scores at various observation time points in the trial group was significantly superior to that in the

关 键 词：老年性膝骨关节炎 针刀疗法 骨疏康颗粒 关节活动度 炎症因子 

分 类 号：R274.9[医药卫生—中西医结合]