单独使用NSAIDs与联合防风汤治疗老年膝关节炎的临床疗效比较  

Comparison of clinical efficacy of NSAIDs alone and in combination with Fangfeng decoction in treatment of knee osteoarthritis in elderly patients

作　　者：郑朝军[1] 王洪年 贾玉虎 胡其生 Zheng Chaojun;Wang Hongnian;Jia Yuhu;Hu Qisheng(Department of Orthopedics,Guanyun Traditional Chinese Medicine Hospital,Lianyungang 222202,China)

机构地区：[1]江苏省灌云县中医院骨二科,江苏连云港222202

出　　处：《中华临床医师杂志（电子版）》2022年第4期343-348,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的旨在比较单独使用双氯芬酸钠和其与防风汤联合应用治疗老年膝关节炎(KOA)的临床疗效。方法将江苏省灌云县中医院2018年1月至2020年1月门诊或住院治疗KOA患者作为研究对象,将其随机分组为对照组(双氯芬酸钠)和联合治疗组(双氯芬酸钠+防风汤),比较2组不良反应发生率、临床有效率,及疼痛视觉评分(VAS)、西大略湖和麦克马斯特大学骨关节炎指数(WOMAC)和膝关节评分系统(Lysholm)。结果最终共纳入了180例KOA患者,对照组和联合治疗组均为90例。对于Kellen-Lawrence(K-L)分级Ⅲ型患者,联合治疗组的有效率优于对照组(100%vs 77.8%,P=0.045)。对于I~Ⅱ、Ⅲ型KOA患者而言,联合治疗组的WOMAC评分较对照组更低(26.88±11.2 vs 38.16±12.8,P<0.001)、(51.89±16.55 vs 70.83±16.37,P=0.001),Lysholm评分更高(76.8±9.48 vs 66.95±13.26,P<0.001)、(51.17±11.2 vs 42.61±10.44,P=0.013)。对于K-L分级Ⅳ型患者,联合治疗组的VAS评分较对照组更低(4.47±1.68 vs 5.93±1.98,P=0.035)。结论防风汤联合双氯芬酸钠对老年KOA患者的效果显著,安全性较好,联合治疗方案对轻中度(I-Ⅲ型)KOA患者的疼痛、僵硬和提高关节功能方面更有显著的优势,对重度(Ⅳ型)患者,联合治疗可以进一步缓解疼痛,值得临床推广。Objective To compare the clinical efficacy of diclofenac sodium alone and in combination with the Chinese traditional medicine Fangfeng decoction in the treatment of knee osteoarthritis(KOA).Methods KOA patients were enrolled at Guanyun Traditional Chinese Medicine Hospital from January 2018 to January 2020.The patients were randomly divided into a control group(diclofenac sodium alone)or a combination group(diclofenac sodium+Fangfeng decoction).The incidence of adverse reactions,clinical response rate,visual analogue scale(VAS)score,Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),and Lysholm score were compared between the two groups.Results Finally,180 patients were included,with 90 patients in each group.For patients with Kellen-Lawrence(K-L)gradeⅢdisease,the combination group had a higher effective rate than the control group(100%vs 77.8%,P=0.045).For patients with K-L grade I/Ⅱdisease and those with K-L gradeⅢdisease,the combination group had lower WOMAC scores(26.88±11.2 vs 38.16±12.8,P<0.001;51.89±16.55 vs 70.83±16.37,P=0.001)and higher Lysholm scores(76.8±9.48 vs 66.95±13.26,P<0.001;51.17±11.2 vs 42.61±10.44,P=0.013)than the control group.For patients with K-L gradeⅣdisease,the combination group had a lower VAS score than the control group(4.47±1.68 vs 5.93±1.98,P=0.035).Conclusion Fangfeng decoction combined with diclofenac sodium has superior efficacy and safety in elderly patients with KOA.The combination treatment has more advantages in management of pain,stiffness,and joint dysfunction in patients with K-L grades I-Ⅲdisease,as well as relief pain in patients with K-L gradeⅣdisease,which is worthy of clinical promotion and reference.

关 键 词：膝关节骨关节炎 双氯芬酸钠 防风汤 中西医治疗 安全性评价 

分 类 号：R684.3[医药卫生—骨科学]