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[1]蔣薇,陳剛.海桐皮湯薰洗聯(lián)合體外沖擊波療法治療輕中度膝骨關(guān)節(jié)炎的療效觀察[J].中醫(yī)正骨,2020,32(04):15-20.
　JIANG Wei,CHEN Gang.Observation on the curative effects of steaming and washing therapy with Haitongpi Tang(海桐皮湯)combined with extracorporeal shock wave therapy for treatment of mild-to-moderate knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(04):15-20.
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海桐皮湯薰洗聯(lián)合體外沖擊波療法治療輕中度膝骨關(guān)節(jié)炎的療效觀察()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年04期
頁碼:
15-20
欄目:
臨床研究
出版日期:
2020-04-20

文章信息/Info

Title:
Observation on the curative effects of steaming and washing therapy with Haitongpi Tang(海桐皮湯)combined with extracorporeal shock wave therapy for treatment of mild-to-moderate knee osteoarthritis
作者:
蔣薇1; 陳剛2
(1.杭州市富陽區(qū)第一人民醫(yī)院,浙江 杭州 311499; 2.杭州市富陽區(qū)中醫(yī)院,浙江 杭州 311499)
Author(s):
JIANG Wei1; CHEN Gang2
1.The First People's Hospital of Fuyang,Hangzhou 311499,Zhejiang,China 2.Fuyang Hospital of Traditional Chinese Medicine,Hangzhou 311499,Zhejiang,China
關(guān)鍵詞:
骨關(guān)節(jié)炎; 膝;  薰洗;  海桐皮湯;  體外沖擊波療法;  透明質(zhì)酸;  白細(xì)胞介素1β;  腫瘤壞死因子α;  C反應(yīng)蛋白質(zhì)
Keywords:
osteoarthritis; knee;  steaming washing therapy;  Haitongpi Tang;  extracorporeal shock wave therapy;  hyaluronic acid;  interleukin-1β;  tumor necrosis factor-α;  C-reactive protein
摘要:
摘 要 目的:探討海桐皮湯薰洗聯(lián)合體外沖擊波療法治療輕中度膝骨關(guān)節(jié)炎(knee osteoarthritis,KOA)的臨床療效。方法:共納入KOA患者75例,男22例、女53例; 年齡50～77歲,中位數(shù)61歲; 病程3～59個(gè)月,中位數(shù)30個(gè)月; Kellgren-Lawrence影像學(xué)分級(jí)Ⅰ級(jí)13例、Ⅱ級(jí)41例、Ⅲ級(jí)21例。隨機(jī)分為2組,中藥聯(lián)合沖擊波組37例、玻璃酸鈉組38例。中藥聯(lián)合沖擊波組采用海桐皮湯薰洗聯(lián)合體外沖擊波治療,中藥薰洗每次30 min,每日1次,連續(xù)治療5周; 體外沖擊波治療每周1次,共治療5次。玻璃酸鈉組采用玻璃酸鈉關(guān)節(jié)腔注射治療,每周1次,共注射5次。分別于治療前及治療結(jié)束后,采用疼痛視覺模擬量表(visual analogue scale,VAS)評(píng)分評(píng)價(jià)患膝疼痛情況,采用西安大略和麥克馬斯特大學(xué)(Western Ontario and McMasters Universities,WOMAC)骨關(guān)節(jié)炎指數(shù)從疼痛、僵硬及日常活動(dòng)3個(gè)方面評(píng)價(jià)臨床療效,采用酶聯(lián)免疫反應(yīng)法測定患者血清白細(xì)胞介素1β(interleukin-1β,IL-1β)和腫瘤壞死因子α(tumor necrosis factor,TNF-α)的含量,采用免疫濁度法測定患者血清超敏C反應(yīng)蛋白質(zhì)(hypersensitive C-reactive protein,hs-CRP)的含量。結(jié)果:2組患者均順利完成治療。①患膝疼痛VAS評(píng)分。治療前,2組患者患膝疼痛VAS評(píng)分的組間差異無統(tǒng)計(jì)學(xué)意義[(4.76±1.28)分,(4.55±1.46)分,t=0.642,P=0.523]; 治療結(jié)束后,2組患者患膝疼痛VAS評(píng)分均低于治療前[(4.76±1.28)分,(1.97±0.96)分,t=12.673,P=0.000;(4.55±1.46)分,(2.42±0.89)分,t=13.258,P=0.000],且中藥聯(lián)合沖擊波組低于玻璃酸鈉組(t=-2.101,P=0.039)。②患膝WOMAC骨關(guān)節(jié)炎指數(shù)。治療前,2組患者患膝WOMAC骨關(guān)節(jié)炎指數(shù)中疼痛、僵硬、日常活動(dòng)評(píng)分及總分的組間差異均無統(tǒng)計(jì)學(xué)意義[(10.08±2.98)分,(9.74±3.30)分,t=0.474,P=0.637;(4.19±1.02)分,(3.84±1.05)分,t=1.447,P=0.152;(34.70±4.10)分,(34.18±3.07)分,t=0.621,P=0.536;(48.97±5.89)分,(47.76±6.38)分,t=0.853,P=0.397]; 治療結(jié)束后,2組患者WOMAC骨關(guān)節(jié)炎指數(shù)各項(xiàng)評(píng)分、總分均低于治療前[中藥聯(lián)合沖擊波組:(10.08±2.98)分,(4.16±1.42)分,t=15.979,P=0.000;(4.19±1.02)分,(1.81±0.88)分,t=20.072,P=0.000;(34.70±4.10)分,(12.95±3.55)分,t=25.644,P=0.000;(48.97±5.89)分,(18.92±3.24)分,t=30.284,P=0.000。玻璃酸鈉組:(9.74±3.30)分,(4.92±1.62)分,t=13.861,P=0.000;(3.84±1.05)分,(2.34±0.97)分,t=18.248,P=0.000;(34.18±3.07)分,(14.87±4.04)分,t=25.572,P=0.000;(47.76±6.38)分,(22.11±4.83)分,t=31.744,P=0.000],且中藥聯(lián)合沖擊波組均低于玻璃酸鈉組(t=-2.154,P=0.035; t=-2.492,P=0.015; t=-2.186,P=0.032; t=-3.361,P=0.001)。③血清炎性因子含量。治療前,2組患者血清IL-1β、TNF-α、hs-CRP含量的組間差異均無統(tǒng)計(jì)學(xué)意義[(72.83±10.49)pg·mL-1,(74.05±9.68)pg·mL-1,t=-0.524,P=0.602;(19.61±4.32)pg·mL-1,(18.59±4.70)pg·mL-1,t=0.980,P=0.330;(8.79±2.07)mg·L-1,(8.22±1.69)mg·L-1,t=1.297,P=0.198]; 治療結(jié)束后,2組患者血清IL-1β、TNF-α、hs-CRP含量均低于治療前[中藥聯(lián)合沖擊波組:(72.83±10.49)pg·mL-1,(34.45±6.47)pg·mL-1,t=21.530,P=0.000;(19.61±4.32)pg·mL-1,(8.35±2.36)pg·mL-1,t=13.359,P=0.000;(8.79±2.07)mg·L-1,(3.61±0.91)mg·L-1,t=14.408,P=0.000。玻璃酸鈉組:(74.05±9.68)pg·mL-1,(41.24±7.04)pg·mL-1,t=18.023,P=0.000;(18.59±4.70)pg·mL-1,(9.64±2.73)pg·mL-1,t=13.493,P=0.000;(8.22±1.69)mg·L-1,(4.53±0.96)mg·L-1,t=15.399,P=0.000],且中藥聯(lián)合沖擊波組均低于玻璃酸鈉組(t=-4.352,P=0.000; t=-2.176,P=0.033; t=-4.217,P=0.000)。結(jié)論:海桐皮湯薰洗聯(lián)合體外沖擊波療法治療輕中度KOA,能緩解患膝疼痛、改善患膝功能、降低血清炎性因子含量,且療效優(yōu)于玻璃酸鈉關(guān)節(jié)腔注射。
Abstract:
Objective:To explore the clinical curative effects of steaming and washing therapy with Haitongpi Tang(海桐皮湯,HTPT)combined with extracorporeal shock wave therapy(ESWT)for treatment of mild-to-moderate knee osteoarthritis(KOA).Methods:Seventy-five patients with KOA were included in the study.The patients consisted of 22 males and 53 females,and ranged in age from 50 to 77 years(Median=61 yrs)and in disease course from 3 to 59 months(Median=30 months).The KOA belonged to gradeⅠ(13),Ⅱ(41)andⅢ(21)according to Kellgren-Lawrence imaging classification criteria.The patients were randomly divided into combination therapy group(37 cases)and sodium hyaluronate group(38 cases),and were treated with combination therapy of steaming and washing with HTPT and ESWT and monotherapy of intra-articular injection of sodium hyaluronate respectively.The steaming and washing therapy with HTPT was performed once a day,30 minutes at a time for consecutive 5 weeks.The ESWT and the intra-articular injection of sodium hyaluronate were performed once a week for totally 5 times.Before the treatment and after the end of the treatment,the knee pain was evaluated by using visual analogue scale(VAS)scores,the clinical curative effects were evaluated by using Western Ontario and McMaster Universities(WOMAC)osteoarthritis indexes including pain,stiffness and activity of daily living(ADL).The serum contents of interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)and the serum contents of hypersensitive C-reactive protein(hs-CRP)were measured by using enzyme-linked immunosorbent assay and immunoturbidimetry respectively.Results:The treatment was finished successfully in all patients.There was no statistical difference in knee pain VAS scores between the 2 groups before the treatment(4.76+/-1.28 vs 4.55+/-1.46 points,t=0.642,P=0.523).The knee pain VAS scores were lower after the end of the treatment compared to pre-treatment,and were lower in combination therapy group compared to sodium hyaluronate group(4.76+/-1.28 vs 1.97+/-0.96 points,t=12.673,P=0.000; 4.55+/-1.46 vs 2.42+/-0.89 points,t=13.258,P=0.000; t=-2.101,P=0.039).There was no statistical difference in the knee WOMAC osteoarthritis indexes including pain scores,stiffness scores,ADL scores and total scores between the 2 groups before the treatment(10.08+/-2.98 vs 9.74+/-3.30 points,t=0.474,P=0.637; 4.19+/-1.02 vs 3.84+/-1.05 points,t=1.447,P=0.152; 34.70+/-4.10 vs 34.18+/-3.07 points,t=0.621,P=0.536; 48.97+/-5.89 vs 47.76+/-6.38 points,t=0.853,P=0.397).The knee WOMAC osteoarthritis indexes including pain scores,stiffness scores,ADL scores and total scores were lower after the end of the treatment compared to pre-treatment,and were lower in combination therapy group compared to sodium hyaluronate group(combination therapy group:10.08+/-2.98 vs 4.16+/-1.42 points,t=15.979,P=0.000; 4.19+/-1.02 vs 1.81+/-0.88 points,t=20.072,P=0.000; 34.70+/-4.10 vs 12.95+/-3.55 points,t=25.644,P=0.000; 48.97+/-5.89 vs 18.92+/-3.24 points,t=30.284,P=0.000.sodium hyaluronate group:9.74+/-3.30 vs 4.92+/-1.62 points,t=13.861,P=0.000; 3.84+/-1.05 vs 2.34+/-0.97 points,t=18.248,P=0.000; 34.18+/-3.07 vs 14.87+/-4.04 points,t=25.572,P=0.000; 47.76+/-6.38 vs 22.11+/-4.83 points,t=31.744,P=0.000; t=-2.154,P=0.035; t=-2.492,P=0.015; t=-2.186,P=0.032; t=-3.361,P=0.001).There was no statistical difference in the serum contents of IL-1β,TNF-α and hs-CRP between the 2 groups before the treatment(72.83+/-10.49 vs 74.05+/-9.68 pg/mL,t=-0.524,P=0.602; 19.61+/-4.32 vs 18.59+/-4.70 pg/mL,t=0.980,P=0.330; 8.79+/-2.07 vs 8.22+/-1.69 mg/L,t=1.297,P=0.198).The serum contents of IL-1β,TNF-α and hs-CRP were lower after the end of the treatment compared to pre-treatment,and were lower in combination therapy group compared to sodium hyaluronate group(combination therapy group:72.83+/-10.49 vs 34.45+/-6.47 pg/mL,t=21.530,P=0.000; 19.61+/-4.32 vs 8.35+/-2.36 pg/mL,t=13.359,P=0.000; 8.79+/-2.07 vs 3.61+/-0.91 mg/L,t=14.408,P=0.000.sodium hyaluronate group:74.05+/-9.68 vs 41.24+/-7.04 pg/mL,t=18.023,P=0.000; 18.59+/-4.70 vs 9.64+/-2.73 pg/mL,t=13.493,P=0.000; 8.22+/-1.69 vs 4.53+/-0.96 mg/L,t=15.399,P=0.000; t=-4.352,P=0.000; t=-2.176,P=0.033; t=-4.217,P=0.000).Conclusion:Steaming and washing therapy with HTPT combined with ESWT can relieve the knee pain,improve the knee function and decrease the serum contents of inflammatory factors in treatment of mild-to-moderate KOA,and its curative effect is better than that of intra-articular injection of sodium hyaluronate.

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(收稿日期:2019-10-15 本文編輯:楊雅)通訊作者:蔣薇 E-mail:[email protected]
更新日期/Last Update: 2020-07-31