摘要
目的:观察经筋理论指导下的针刀松解术联合热敏灸治疗阳虚寒凝型早中期膝骨关节炎的效果。方法:选取78例阳虚寒凝型膝骨关节炎患者,采用随机数字表法分为观察组和对照组各39例。观察组采用经筋理论指导下的针刀松解术联合热敏灸治疗,对照组采用常规定点针刀松解术联合热敏灸治疗,2组均治疗3周。治疗前后评定症状评分、膝关节疼痛视觉模拟评分法(VAS)评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分,检测关节液中的炎症因子[白细胞介素(IL)-1β、IL-18、肿瘤坏死因子-α (TNF-α)]、骨代谢因子[骨钙素(BGP)、抗酒石酸盐酸性磷酸酶异构体(TRACP-5b)、骨特异性碱性磷酸酶(BALP)]及软骨细胞外基质代谢因子[基质金属蛋白酶-3 (MMP-3)、金属蛋白酶组织抑制因子-1 (TIMP-1)、软骨寡聚基质蛋白(COMP)]水平。比较2组的临床疗效,并进行安全性评价与随访观察。结果:治疗后,观察组临床疗效总有效率94.87%,高于对照组(79.49%),差异有统计学意义(P<0.05)。2组症状积分、膝关节疼痛VAS评分均治疗前降低(P<0.05),观察组症状积分、膝关节疼痛VAS评分均低于对照组(P<0.05)。2组WOMAC疼痛、僵硬、关节功能评分均较治疗前降低(P<0.05),观察组3项评分均低于对照组(P<0.05)。2组关节液中的IL-1β、IL-18、TNF-α、TRACP-5b、MMP-3、COMP水平均较治疗前降低,BALP、BGP、TIMP-1水平均较治疗前升高,差异均有统计学意义(P<0.05)。观察组IL-1β、IL-18、TNF-α、TRACP-5b、MMP-3、COMP水平均低于对照组,BALP、BGP、TIMP-1水平均高于对照组,差异均有统计学意义(P<0.05)。2组患者在治疗期间均未出现晕针、断针、神经损伤、术口感染等不良反应。随访6个月,观察组复发率低于对照组(P<0.05)。结论:使用经筋理论指导下的针刀松解术联合热敏灸治疗阳虚寒凝型早中期膝骨关节炎效果显著,安全性高,可能与调节炎症因子、骨代谢因子及软骨细胞外基质代谢因子有关。
Objective:To observe the effect of acupotomy combined with heat-sensitive moxibustion for knee osteoarthritis with yang deficiency and congealing cold syndrome in early and middle stage guided by meridian sinew theory.Methods:A total of 78 cases of patients with knee osteoarthritis with yang deficiency and congealing cold syndrome were selected and divided into the observation group and the control group according to the random number table method,with 39 cases in each group.The observation group was treated with acupotomy combined with heat-sensitive moxibustion guided by meridian sinew theory,and the control group was treated with acupotomy at routine fixed points combined with heat-sensitive moxibustion.Both groups were treated for 3 weeks.Before and after treatment,the scores of symptoms,Visual Analogue Scale(VAS)in knee pain,and Western Ontario and Mcmaster Universities Osteoarthritis Index(WOMAC)were evaluated,and the levels of inflammatory factors in synovial fluid including interleukin(IL)-1β,IL-18 and tumour necrosis factor-α(TNF-α),bone metabolism factors including bone Gla protein(BGP),tartrate-resistant acid phosphatase 5b(TRACP-5b)and bone alkaline phosphatase(BALP),and metabolic factors of cartilage extracellular matrix including matrix metalloproteinase-3(MMP-3),tissue inhibitor of metalloproteinases-1(TIMP-1),and cartilage oligomeric matrix protein(COMP)were detected.The clinical effects in the two groups were compared,and the safety evaluation and follow-up observation were carried out.Results:After treatment,the total clinical effective rate was 94.87%in the observation group,higher than that of 79.49%in the control group,the difference being significant(P<0.05).The scores of Chinese medicine symptoms and VAS in knee pain in the two groups were decreased when compared with those before treatment(P<0.05),and the scores of Chinese medicine symptoms and VAS in knee pain in the observation group were lower than those in the control group(P<0.05).The scores of pain,stiffness,and joint function in WOMAC were decreased when compared with those before treatment(P<0.05),and the three scores in the observation group were lower than those in the control group(P<0.05).The levels of IL-1β,IL-18,TNF-α,TRACP-5b,MMP-3,and COMP in synovial fluid in the two groups were decreased when compared with those before treatment,and the levels of BALP,BGP,and TIMP-1 were increased when compared with those before treatment,differences being significant(P<0.05).The levels of IL-1β,IL-18,TNF-α,TRACP-5b,MMP-3,and COMP in the observation group were lower than those in the control group,and the levels of BALP,BGP,and TIMP-1 were higher than those in the control group,differences being significant(P<0.05).There was no adverse reaction such as fainting,broken needles,nerve injury,and wound infection during treatment in the two groups.In the six-month follow-up,the recurrence rate in the observation group was lower than that in the control group(P<0.05).Conclusion:The treatment of acupotomy combined with heat-sensitive moxibustion guided by meridian sinew theory has a significant effect in treating knee osteoarthritis in early and middle stage with high safety,which may be related to the regulation of levels of inflammatory factors,bone metabolism factors,and metabolic factors of cartilage extracellular matrix.
作者
赵松阳
徐辉
郑玉宽
ZHAO Songyang;XU Hui;ZHENG Yukuan(The Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou He'nan 450052,China)
出处
《新中医》
CAS
2023年第16期157-163,共7页
New Chinese Medicine
关键词
膝骨关节炎
阳虚寒凝证
经筋理论
针刀松解术
热敏灸
炎症因子
骨代谢
软骨细胞外基质代谢
Knee osteoarthritis
Yang deficiency and congealing cold syndrome
Meridian sinew theory
Acupotomy
Heat-sensitive moxibustion
Inflammatory factors
Bone metabolism
Metabolism of cartilage extracellular matrix
作者简介
赵松阳(1984-),男,,主治医师,E-mail:songyangzhao@163.com;通信作者:徐辉(1973-),男,副主任医师,E-mail:364958286@q.com。
