三联序贯通痹法治疗早期膝骨关节炎30例临床观察(1)
【摘 要】目的：观察运用三联序贯通痹法治疗早期膝骨关节炎风寒湿痹型的临床疗效。方法：将60例早期膝骨关节炎患者随机分为治疗组和对照组，每组30例。治疗组采用三联序贯通痹法外用，对照组口服双氯芬酸钠缓释胶囊。2组1个疗程均为4周。观察2组临床疗效，以及治疗前后视觉模拟评分法(VAS)评分、膝骨关节炎严重性指数(ISOA)评分，检测外周血白细胞介素-6、肿瘤坏死因子-α水平，并记录安全性指标。结果：治疗组临床控制8例，显效12例，有效8例，无效2例，总有效率为93.33%；对照组临床控制6例，显效15例，有效4例，无效5例，总有效率为83.33%。2组比较，差异无统计学意义(P > 0.05)。治疗后，2组VAS评分、ISOA各项评分、白细胞介素-6、肿瘤坏死因子-α较治疗前均有改善(P < 0.05或P < 0.01)，且治疗组优于对照组(P < 0.01)。2组患者均未见明显不良反应。结论：采用三联序贯通痹法综合治疗早期膝骨关节炎风寒湿痹型患者，能够有效控制炎症反应，减轻症状，且无明显不良反应。
【关键词】 骨关节炎，膝；早期；风寒湿痹型；三联序贯通痹法；炎症反应；临床疗效
【ABSTRACT】Objective：To observe the clinical efficacy of three-step sequential therapy in the treatment of early knee osteoarthritis of wind-cold-dampness type.Methods：Sixty patients with early knee osteoarthritis were randomly divided into a treatment group and a control group，30 cases in each group.The treatment group was treated with three-step sequential therapy，while the control group was treated with Diclofenac Sodium Sustained Release Capsules.The two groups were treated for four weeks.The clinical effects of both groups were observed，as well as the changes of VAS and ISOA.The levels of interleukin-6 and TNF-α in peripheral blood were detected，and the safety indexes were recorded.Results：In the treatment group，8 cases were clinically controlled，12 cases were markedly effective，8 cases were effective and 2 cases were ineffective，with a total effective rate of 93.33%；while in the control group，6 cases were clinically controlled，15 cases were markedly effective，4 cases were effective and 5 cases were ineffective，and the total effective rate was 83.33%.There was no significant difference between the two groups(P > 0.05).After treatment，VAS scores，ISOA scores，interleukin -6 and TNF-α of the two groups were better than before treatment(P < 0.05 or P < 0.01)，and the treatment group was better than the control group(P < 0.01).No obvious adverse reaction was found in the two groups after treatment.Conclusion：Treating early knee osteoarthritis of wind-cold-dampness type with three-step sequential therapy can effectively control the inflammatory reaction and alleviate the symptoms，having no obvious adverse reactions.
【Keywords】 osteoarthritis，knee；early stage；wind-cold-dampness type；three-step sequential therapy；inflammatory reaction；
clinical efficacy
1986年美國风湿病学会(ACR)将骨关节病定义为：关节症状、体征与关节软骨完整性受损，关节边缘骨赘形成和软骨下骨发生相应的病理改变(包括微骨折和囊性变)而引起的关节症候群。1995年国际骨关节炎专题研讨会进一步提出：膝骨关节炎(knee osteoarthritis，KOA)是在力学和生物学因素的配合下使软骨细胞、软骨下骨及细胞外基质降解和合成失衡的结果。而所谓的早期KOA，LUYTEN等[1]则认为应符合：①明确膝关节疼痛；②符合影像学Kellgren-Lawrence(K-L)X线分级标准中的0期和(或)Ⅰ期，或Ⅱ期中无关节间隙狭窄改变；③关节镜或者磁共振检查提示关节软骨变性及损伤。KOA属中医学“痹证”范畴，称为“膝痹”。风、寒、湿邪留注肌肉、筋骨、关节，造成经络壅塞，气血运行不畅，肢体筋脉拘急、失养为本病的基本病机。中医药外治法治疗KOA可追溯上千年历史，具有无创伤、价廉、治疗效果快等优势，患者愿意接受，医患关系更和谐。贵阳中医学院第二附属医院风湿免疫科协定方通痹酊药酒、海桐皮汤、五藤散药膏，在此基础上进行改进、深化和提高，将上述药方联合组成的三联序贯通痹法在临床应用并已取得良好疗效[2-3]。笔者运用三联序贯通痹法治疗早期KOA风寒湿痹型患者60例，现总结报告如下。, 百拇医药(兰维娅 唐芳 马武开 周静 卢向阳 陈琳英 李宇 蒋总)
【关键词】 骨关节炎，膝；早期；风寒湿痹型；三联序贯通痹法；炎症反应；临床疗效
【ABSTRACT】Objective：To observe the clinical efficacy of three-step sequential therapy in the treatment of early knee osteoarthritis of wind-cold-dampness type.Methods：Sixty patients with early knee osteoarthritis were randomly divided into a treatment group and a control group，30 cases in each group.The treatment group was treated with three-step sequential therapy，while the control group was treated with Diclofenac Sodium Sustained Release Capsules.The two groups were treated for four weeks.The clinical effects of both groups were observed，as well as the changes of VAS and ISOA.The levels of interleukin-6 and TNF-α in peripheral blood were detected，and the safety indexes were recorded.Results：In the treatment group，8 cases were clinically controlled，12 cases were markedly effective，8 cases were effective and 2 cases were ineffective，with a total effective rate of 93.33%；while in the control group，6 cases were clinically controlled，15 cases were markedly effective，4 cases were effective and 5 cases were ineffective，and the total effective rate was 83.33%.There was no significant difference between the two groups(P > 0.05).After treatment，VAS scores，ISOA scores，interleukin -6 and TNF-α of the two groups were better than before treatment(P < 0.05 or P < 0.01)，and the treatment group was better than the control group(P < 0.01).No obvious adverse reaction was found in the two groups after treatment.Conclusion：Treating early knee osteoarthritis of wind-cold-dampness type with three-step sequential therapy can effectively control the inflammatory reaction and alleviate the symptoms，having no obvious adverse reactions.
【Keywords】 osteoarthritis，knee；early stage；wind-cold-dampness type；three-step sequential therapy；inflammatory reaction；
clinical efficacy
1986年美國风湿病学会(ACR)将骨关节病定义为：关节症状、体征与关节软骨完整性受损，关节边缘骨赘形成和软骨下骨发生相应的病理改变(包括微骨折和囊性变)而引起的关节症候群。1995年国际骨关节炎专题研讨会进一步提出：膝骨关节炎(knee osteoarthritis，KOA)是在力学和生物学因素的配合下使软骨细胞、软骨下骨及细胞外基质降解和合成失衡的结果。而所谓的早期KOA，LUYTEN等[1]则认为应符合：①明确膝关节疼痛；②符合影像学Kellgren-Lawrence(K-L)X线分级标准中的0期和(或)Ⅰ期，或Ⅱ期中无关节间隙狭窄改变；③关节镜或者磁共振检查提示关节软骨变性及损伤。KOA属中医学“痹证”范畴，称为“膝痹”。风、寒、湿邪留注肌肉、筋骨、关节，造成经络壅塞，气血运行不畅，肢体筋脉拘急、失养为本病的基本病机。中医药外治法治疗KOA可追溯上千年历史，具有无创伤、价廉、治疗效果快等优势，患者愿意接受，医患关系更和谐。贵阳中医学院第二附属医院风湿免疫科协定方通痹酊药酒、海桐皮汤、五藤散药膏，在此基础上进行改进、深化和提高，将上述药方联合组成的三联序贯通痹法在临床应用并已取得良好疗效[2-3]。笔者运用三联序贯通痹法治疗早期KOA风寒湿痹型患者60例，现总结报告如下。, 百拇医药(兰维娅 唐芳 马武开 周静 卢向阳 陈琳英 李宇 蒋总)